Nonopioid Analgesia Is as Effective as Opioids Following Minor or Moderate Surgeries

Bruce Soloway, MD, reviewing Fiore JF Jr et al. Lancet 2022 Jun 18

Prescribing opioids for postoperative pain relief is common in the U.S. and contributes to opioid overuse, dependence, and illicit diversion. Elsewhere in the world, nonopioid drugs are prescribed commonly for postop pain relief, but the comparative effectiveness of opioid and nonopioid postoperative analgesia remains uncertain.

In a meta-analysis, researchers reviewed 47 randomized trials in which researchers compared the effectiveness of multidose opioid and opioid-free postoperative analgesia in 6600 adolescents and adults (age, ≥15) following surgeries described as minor (e.g., dental or skin procedures) or moderate (e.g., minimally invasive orthopedic surgeries). Most trials (85%) involved day surgeries, and half involved outpatient procedures. Opioid drugs were primarily codeine (in 43% of trials), hydrocodone (23%), and tramadol (19%); nonopioid drugs were primarily nonsteroidal anti-inflammatory drugs and acetaminophen.

Pain intensity at 1 day after discharge and at other postoperative timepoints was similar among patients who received opioid drugs or nonopioid drugs. Opioids, compared with nonopioids, were associated with excess risk for vomiting (11% vs. 1% of recipients), as well as excess nausea, constipation, dizziness, and drowsiness. No trial included data on opioid dependence or misuse.