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עברית
Bruce Soloway, MD, reviewing Fiore JF Jr et al. Lancet 2022 Jun 18
Opioids are associated with excess vomiting and other side effects.
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.
CITATIONS
Fiore JF Jr et al. Opioid versus opioid-free analgesia after surgical discharge: A systematic review and meta-analysis of randomised trials. Lancet 2022 Jun 18; 399:2280.
COMMENT
Preoperative medical assessments provide generalists with an opportunity to advise patients who will be undergoing minor or moderate surgeries about nonopioid analgesia: Nonopioid agents should be sufficient for pain relief after discharge, even mild opioids carry substantial risks for adverse effects, and opioid prescriptions can be declined if they are offered. Results of this analysis cannot be generalized to major surgeries.