Impact of a perioperative oral opioid substitution protocol during the nationwide intravenous opioid shortage: A single center, interrupted time series with segmented regression analysis

Salajegheh, Reza; Nemergut, Edward C.; Rice, T; Joseph, Roy; Tsang, Siny; Sarosiek, Bethany M.; Muthusubramanian, C Paige; Hipwell, Katelyn M; Horton, Kate B; Naik, Bhiken I.

doi:10.1371/journal.pone.0234199

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…One potential cost savings is the use of oral analgesics compared to IV medications. During an institutional opioid shortage, Salajegheh et al 42 compared the effectiveness of oral opioids compared to IV and found no difference in patient pain scores. Moreover, they reported that overall opioid use during this time decreased.…”

Section: Conmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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Enhanced recovery after surgery (ERAS) protocols are standardized and designed to provide superior analgesia, reduce opioid consumption, improve patient recovery, and reduce hospital length of stay. Yet, moderate-to-severe postsurgical pain continues to afflict over 40% of patients and remains a major priority for anesthesia research. Methadone administration in the perioperative setting may reduce postoperative pain scores and have opioid-sparing effects, which may be beneficial for enhanced recovery. Methadone possesses a multimodal profile consisting of µ-opioid agonism, N-methyl-d-aspartate (NMDA) receptor antagonism, and reuptake inhibition of serotonin and norepinephrine. Furthermore, it may attenuate the development of chronic postsurgical pain. However, caution is advised with perioperative use of methadone in specific high-risk patient populations and surgical settings. Methadone's wide pharmacokinetic variability, opioid-related adverse effects, and potential negative impact on cost-effectiveness may also limit its use in the perioperative setting. In this PRO-CON commentary article, the authors debate whether methadone should be incorporated in ERAS protocols to provide superior analgesia with no increased risks.

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Section: Conmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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“…8 In contrast, the reported impact of injectable opioid shortages in the pediatric, emergency department, and intraoperative/immediate postoperative settings have been less detrimental and were in fact associated with reduced opioid use and no worsening of pain. 7,9,10 The differences in findings may reflect not only the practice setting, but also the patient samples, outcomes evaluated, and strategies used at each facility to manage the drug product shortages. Because injectable opioid shortages are likely to continue, further research on how best to manage the impact is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Use of these alternative approaches has been shown to decrease total opioid doses, reduce pain scores, and reduce hospital length of stay. [5][6][7] Despite the concerns over injectable opioid shortages and reported impacts in some settings, [8][9][10] little is known about how these shortages affect outcomes for adult patients requiring acute pain management while hospitalized postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Acute Postoperative Pain Management During an Injectable Opioid Shortage

et al. 2020

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Background: Drug product shortages, including injectable opioids, are common and have the potential to adversely affect patient care. Objective: To evaluate the impact of an injectable opioid shortage for hospitalized adult patients in the acute postoperative setting. Methods: A single-center, retrospective cohort study of noncritically ill hospitalized, postoperative patients requiring opioids for acute pain management was conducted. Patient cohorts were compared preshortage and postshortage for proportion of total intravenous (IV) opioids used, proportions of specific pain medications used, subjective pain scores, 30-day mortality, respiratory depression, need for opioid reversal, hospital length of stay, and opioid equivalent doses. Results: A total of 275 patients were included, 130 patients in the preshortage cohort and 145 in the postshortage cohort. The proportion of total IV opioid doses was lower in the postshortage cohort versus the preshortage cohort (16.6% vs 20.5%; P < 0.01). Specific medications used were significantly different between the cohorts. The proportion of severe pain scores was lower in the postshortage cohort versus the preshortage cohort (55.6% vs 58.5%; P = 0.04). No significant differences were seen in the overall proportion of nonopioid analgesic use, 30-day mortality, respiratory depression, need for emergent opioid reversal, hospital length of stay, or opioid equivalent doses between cohorts. Conclusion and Relevance: In hospitalized, postoperative adults, an injectable opioid shortage was associated with significant decreases in IV opioid use and severe pain scores but no significant differences in nonopioid analgesic use, safety outcomes, or opioid equivalent doses. These results may assist clinicians in developing strategies for injectable opioid shortages and generating hypotheses for future studies.

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“…Oral pain management prior to surgery can effectively reduce postoperative pain [9]. During a nationwide IV opioid shortage, Salajegheh et al compared the effect of oral opioids administered compared to intravenous opioids on patient outcomes at our institution [10]. The results showed no difference in pain scores between the two groups, despite oral opioids being used more commonly than IV.…”

Section: Introductionmentioning

confidence: 99%

Comparison of oral versus intravenous methadone on postoperative pain and opioid use after adult spinal deformity surgery: A retrospective, non-inferiority analysis

et al. 2023

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Objective To compare efficacy of oral versus intravenous (IV) methadone on postoperative pain and opioid requirements after spine surgery. Methods This was a retrospective, single-academic center cohort study evaluating 1010 patients who underwent >3 level spine surgery from January 2017 to May 2020 and received a one-time dose of oral or intravenous methadone prior to surgery. The primary outcome measured was postoperative opioid use in oral morphine equivalents (ME) and verbal response scale (VRS) pain scores up to postoperative day (POD) three. Secondary outcomes were time to first bowel movement and adverse effects (reintubation, myocardial infarction, and QTc prolongation) up to POD 3. Results A total of 687 patients received oral and 317 received IV methadone, six patients were excluded. The IV group received a significantly greater methadone morphine equivalent (ME) dose preoperatively (112.4 ± 83.0 mg ME versus 59.3 ± 60.9 mg ME, p < 0.001) and greater total (methadone and non-methadone) opioid dose (119.1 ± 81.4 mg ME versus 63.9 ± 62.5 mg ME, p < 0.001), intraoperatively. Although pain scores for the oral group were non-inferior to the IV group for all postoperative days (POD), non-inferiority for postoperative opioid requirements was demonstrated only on POD 3. Based on the joint hypothesis for the co-primary outcomes, oral methadone was non-inferior to IV methadone on POD 3 only. No differences in secondary outcomes, including QTc prolongation and arrhythmias, were noted between the groups. Conclusions Oral methadone is a feasible alternative to IV methadone for patients undergoing spine surgery regarding both pain scores and postoperative opioid consumption.

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Impact of a perioperative oral opioid substitution protocol during the nationwide intravenous opioid shortage: A single center, interrupted time series with segmented regression analysis

Cited by 5 publications

References 17 publications

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Evaluation of Acute Postoperative Pain Management During an Injectable Opioid Shortage

Comparison of oral versus intravenous methadone on postoperative pain and opioid use after adult spinal deformity surgery: A retrospective, non-inferiority analysis

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