Articles: opioid.
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Persistent opioid use (POU) is a common marker of harm related to opioid use after trauma. This study determined the incidence and risk factors for POU after hospitalisation due to trauma in New Zealand, among opioid-naïve patients. This was a population-based, retrospective cohort study, using linked data, involving all trauma patients of any age admitted to all NZ hospitals between 2007 and 2019. ⋯ The opioid exposure risk factors associated with POU included switching between different opioids (adjusted odds ratio [aOR] 2.62; 95% confidence interval [CI] 2.51-2.73), prescribed multiple opioids (vs codeine, aOR 1.44; 95% CI 1.37-1.53), slow-release opioid formulations (aOR 1.32; 95% CI 1.26-1.39), and dispensed higher total doses of on the initial discharge prescription (aOR 1.26; 95% CI 1.20-1.33). Overall, 1 in 7 opioid-naïve patients who were exposed to opioids after trauma developed POU. Our findings highlight clinicians should be aware of these factors when continuing opioids on discharge.
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Acta Anaesthesiol Scand · Jan 2025
Procedure time-of-day effects on postoperative opioid requirements in children.
Postoperative analgesic requirements in adults follow circadian rhythm patterns with requirements for opioids and local anesthetics highest in the morning. Procedure time of day may also potentially affect circadian rhythm patterns with surgery at night promoting wakefulness during nighttime hours. This disruption may produce a shift in the circadian rhythm and potentially affect when postoperative opioid requirements are highest. We hypothesized that children undergoing surgery at night would have higher postoperative opioid requirements during nighttime hours secondary to a shift in the circadian rhythm with those requirements remaining higher than daytime requirements for the duration of the hospital stay. ⋯ We found that procedure time of day did not impact postoperative opioid requirements in children undergoing a laparoscopic appendectomy for complicated appendicitis. Both children undergoing an appendectomy during the day or at night required more morphine equivalents during daytime hours than during nighttime hours. Surgery at night did not produce a shift in opioid requirements postoperatively from daytime hours to nighttime hours in children undergoing an appendectomy at night.
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No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. ⋯ For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.
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Pediatric emergency care · Jan 2025
Observational StudyAt-home Administration of Opioid Analgesia in Children After Reduction of Forearm Fracture.
Controversy exists surrounding which agents best provide analgesia in children with fractures. Prior studies have demonstrated that ED visits for fracture-related pain have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent at controlling acute fracture-related pain. In a time when one must balance the risk of inadequate pain control with potential opioid misuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home. ⋯ We observed a large range in the number of doses of oxycodone prescribed at discharge and a significant difference between the number of doses being prescribed and those being used by families. A prescription of 2 doses of oxycodone would be sufficient to treat postreduction pain in the majority of children.
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Low back pain (LBP) is a leading reason for opioid use and a closer examination of opioid use and productivity losses among these patients is needed. We identify opioid use trajectories using a group-based trajectory model (GBTM) and estimate productivity losses across the trajectories. ⋯ This was the first study to estimate trajectories of opioids in the two time periods before and after a diagnosis of low back pain. For the first time, productivity losses were also estimated across the identified opioid use trajectories.