Long-term opioid use in seniors following hip and knee arthroplasty in Ontario: a historical cohort study

Le rôle des anesthésiologistes dans la réduction des préjudices liés aux opioïdes

“…This month's Special Issue of the Journal, dedicated to the topic of opioid analgesia for surgical patients, features an array of studies from across Canada on postoperative opioid prescription patterns, their associations with shortand long-term opioid use, and associated downstream effects. [1][2][3][4][5][6][7] While numerous factors inform perioperative opioid use and the data in these studies speak to a multitude of aspects, we ask what role we, as anesthesiologists, can play in reducing opioid-related harm to patients? Most patients after major surgery have a time-limited course of acute pain that dissipates; however, an unfortunate 5-35% develop severe chronic postsurgical pain (CPSP) that leads to significant pain disability one year after surgery.…”

“…22 Le nume ´ro spe ´cial de ce mois-ci du Journal, consacre ´au sujet de l'analge ´sie opioı ¨de pour les patients chirurgicaux, pre ´sente un e ´ventail d'e ´tudes provenant de partout au Canada sur les tendances de prescription d'opioı ¨des postope ´ratoires, leurs associations avec la consommation d'opioı ¨des a `court et a `long terme, et les effets qui leur sont associe ´s en aval. [1][2][3][4][5][6][7] Bien que de nombreux facteurs e ´clairent l'utilisation pe ´riope ´ratoire d'opioı ¨des et que les donne ´es de ces e ´tudes traitent d'une multitude d'aspects, nous nous demandons quel ro ˆle nous, en tant qu'anesthe ´siologistes, pouvons jouer dans la re ´duction des pre ´judices lie ´s aux opioı ¨des pour les patients.…”

In reply: Use of a provincial prescription monitoring database to characterize perioperative opioid prescribing for hip and knee arthroplasty

“…There have been numerous published reports examining postoperative opioid use, with a wide range of results regarding incidence of prolonged use and risk factors such as preoperative opioid consumption. [2][3][4][5] In our study of over 135,000 senior patients undergoing hip or knee arthroplasty in Ontario, 19.5% had filled opioid prescriptions within 90 days prior to surgery, and 27.5% were still receiving opioids 6-12 months after surgery, whether or not they had been prescribed opioids preoperatively. 2 In contrast, in the descriptive study by Milne et al, only 0.25% of opioid naı ¨ve patients filled prescriptions up to six months postoperatively.…”

“…[2][3][4][5] In our study of over 135,000 senior patients undergoing hip or knee arthroplasty in Ontario, 19.5% had filled opioid prescriptions within 90 days prior to surgery, and 27.5% were still receiving opioids 6-12 months after surgery, whether or not they had been prescribed opioids preoperatively. 2 In contrast, in the descriptive study by Milne et al, only 0.25% of opioid naı ¨ve patients filled prescriptions up to six months postoperatively. Other studies have shown a wide range of proportions of opioid naı ¨ve patients who continue opioids chronically after surgery.…”

Perioperative medication management for older people

“…63,71 Initiating regular long-acting preparations also increases the likelihood of long-term opioid use, 72 which is associated with multiple adverse effects, including chronic constipation and risk of fracture. 73 A significant proportion of patients remain on opioids well beyond the perioperative period, 74 highlighting the importance of patient counselling and a postoperative plan for review and deprescribing.…”