Comparison of total morphine milligram equivalents at hospital discharge between opioid-naive and opioid-experienced surgical patients: a single-centre retrospective cohort study.
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BORIS DOI
Publisher DOI
PubMed ID
41158698
Description
Background
Perioperative pain management is a key concern amid the growing opioid pandemic, particularly for opioid-experienced patients. This retrospective single-centre cohort study aimed to compare morphine milligram equivalents (MME) at hospital discharge between opioid-naive and opioid-experienced adults undergoing surgery with postoperative patient-controlled analgesia (PCA). We hypothesised that opioid-experienced patients would require higher MME at discharge, and greater intraoperative remifentanil and postoperative PCA use.Methods
We retrospectively analysed 406 patients from 2016 to 2023 who received intravenous PCA for acute postoperative pain management. Trauma and neuraxial/regional block cases were excluded; emergency non-trauma cases included. Opioid-experienced patients were defined as chronic use of opioids for ≥3 months before surgery. The primary outcome was opioid dose at discharge in MME. Secondary outcomes were total intraoperative remifentanil dose and total PCA use in MME, analysed using multiple linear regression with permutation testing.Results
Opioid-experienced patients had a 15.4 MME day-1 higher discharge opioid dose (95% confidence interval [CI] 7.4-23.4 MME day-1; P<0.001), received 6.7× more opioids at discharge than opioid-naive patients (63.5 vs 9.4 MME day-1; P<0.001) and nearly doubled their own preoperative use (63.5 vs 30 MME day-1). Opioid-experienced patients also required 52.0 MME day-1 more via PCA (95% CI 13.1-90.8 MME day-1; P=0.009). Each additional preoperative MME was associated with a 0.9 MME day-1 increase in PCA use during the hospitalisation (95% CI 0.2-1.6 MME day-1; P=0.017).Conclusions
Preoperative opioid experience strongly predicted postoperative opioid requirements and discharge prescribing. Early identification of opioid-experienced patients and tailored multimodal strategies may improve individualised pain management. However, the retrospective single-centre design and lack of non-opioid analgesia data limit generalisability.
Perioperative pain management is a key concern amid the growing opioid pandemic, particularly for opioid-experienced patients. This retrospective single-centre cohort study aimed to compare morphine milligram equivalents (MME) at hospital discharge between opioid-naive and opioid-experienced adults undergoing surgery with postoperative patient-controlled analgesia (PCA). We hypothesised that opioid-experienced patients would require higher MME at discharge, and greater intraoperative remifentanil and postoperative PCA use.Methods
We retrospectively analysed 406 patients from 2016 to 2023 who received intravenous PCA for acute postoperative pain management. Trauma and neuraxial/regional block cases were excluded; emergency non-trauma cases included. Opioid-experienced patients were defined as chronic use of opioids for ≥3 months before surgery. The primary outcome was opioid dose at discharge in MME. Secondary outcomes were total intraoperative remifentanil dose and total PCA use in MME, analysed using multiple linear regression with permutation testing.Results
Opioid-experienced patients had a 15.4 MME day-1 higher discharge opioid dose (95% confidence interval [CI] 7.4-23.4 MME day-1; P<0.001), received 6.7× more opioids at discharge than opioid-naive patients (63.5 vs 9.4 MME day-1; P<0.001) and nearly doubled their own preoperative use (63.5 vs 30 MME day-1). Opioid-experienced patients also required 52.0 MME day-1 more via PCA (95% CI 13.1-90.8 MME day-1; P=0.009). Each additional preoperative MME was associated with a 0.9 MME day-1 increase in PCA use during the hospitalisation (95% CI 0.2-1.6 MME day-1; P=0.017).Conclusions
Preoperative opioid experience strongly predicted postoperative opioid requirements and discharge prescribing. Early identification of opioid-experienced patients and tailored multimodal strategies may improve individualised pain management. However, the retrospective single-centre design and lack of non-opioid analgesia data limit generalisability.
Date of Publication
2025-12
Publication Type
Article
Subject(s)
Keyword(s)
intravenous opioid
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opioid dose at discharge
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opioid status
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patient-controlled analgesia
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postoperative pain management
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postsurgical opioid use
Language(s)
en
Contributor(s)
Liblik, Elis | |
Hickmann, Anne-Katrin |
Additional Credits
Series
BJA Open
Publisher
Elsevier
ISSN
2772-6096
Access(Rights)
open.access