Long-term analgesic and opioid prescription after surgery under general or neuraxial anesthesia: A retrospective nationwide sampling study.

ABSTRACT

STUDY OBJECTIVE: Chronic postsurgical pain (CPSP) is a common and underreported but significant outcome following surgery. Pharmacological treatment with analgesics, including non-opioids and opioids, is frequently used. It has been debated whether neuraxial anesthesia can reduce persistent analgesic use. We aimed to survey long-term analgesic prescription after different surgeries under general and neuraxial anesthesia, using a nationwide database. DESIGN: Retrospective case-control study. SETTING: This study used data corresponding to the period from 2000 to 2016 from a longitudinal generation tracking database, which includes the claims data of 2 million randomly selected beneficiaries in Taiwan. PATIENTS Patients (n = 110,654) who underwent herniorrhaphy, hip/knee replacement, and lower-limb open reduction internal fixation (ORIF) or amputation were enrolled. INTERVENTIONS: We categorized patients into general or neuraxial anesthesia groups, compared the rates of long-term analgesic prescription between the two groups, and estimated the adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) using multivariable logistic regression analysis. MAIN RESULTS: Lower rates of long-term analgesic prescription were noted in patients who underwent herniorrhaphy (3 months post-surgery aOR, 0.88; 95% CI, 0.84-0.93; 6 months post-surgery aOR, 0.90; 95% CI, 0.84-0.96), hip replacement (3 months post-surgery aOR, 0.91; 95% CI, 0.85-0.97), and lower-limb ORIF (3 months post-surgery aOR, 0.91; 95% CI, 0.88-0.94; 6 months post-surgery aOR, 0.95; 95% CI, 0.92-0.99) under neuraxial anesthesia than under general anesthesia. Lesser long-term opioid prescription after herniorrhaphy (3 months post-surgery aOR, 0.52; 95% CI, 0.36-0.75; 6 months post-surgery aOR, 0.58; 95% CI, 0.42-0.81) and lower-limb ORIF (3 months post-surgery aOR, 0.55; 95% CI, 0.47-0.65; 6 months post-surgery aOR, 0.67; 95% CI, 0.56-0.80) was observed under neuraxial anesthesia than under general anesthesia. CONCLUSIONS: Neuraxial anesthesia may be associated with lower rates of long-term analgesic and opioid prescription after some surgeries, especially herniorrhaphy and lower-limb ORIF.