Persistent Opioid Usage After Urologic Intervention and the Impact of Tramadol

Wackerbarth, Joel; Ham, Sandra A.; Aizen, Joshua; Richgels, John; Faris, Sarah

doi:10.1016/j.urology.2021.07.018

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…Supporting the potential beneficial impact of tramadol in modifying chronic opioid use risk, DeMik et al —focusing on preoperative opioid use as a predictor of postoperative chronic opioid use—found that preoperative tramadol use (as opposed to other opioids) was associated with a lower risk of postoperative chronic opioid use 12. Nevertheless, our findings differ from those reported by Thiels et al , which showed that use of tramadol alone postoperatively was associated with an increased risk of chronic opioid use; a similar finding was observed by Wackerbarth et al in a non-orthopedic setting 13 14. A crucial difference between these studies and the current study is the focus on highly standardized elective orthopedic surgeries.…”

Section: Discussionsupporting

confidence: 77%

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty

Kiani

Poeran

Zhong

et al. 2022

Reg Anesth Pain Med

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IntroductionWe aimed to study the association between tramadol prescribed at discharge (after elective total hip and knee arthroplasty (THA/TKA) surgery) and chronic opioid use postoperatively.MethodsThis retrospective cohort study queried the Truven MarketScan database and identified patients who underwent an elective THA/TKA surgery between 2016 and 2018 and were prescribed opioids at discharge (n=81 049). Multivariable analysis was conducted to study the association between tramadol prescription at discharge and chronic opioid use, with additional analysis adjusting for the amount of opioids prescribed in oral morphine equivalents. Chronic opioid use was defined as filling ≥10 opioid prescriptions or prescriptions for ≥120 pills within the period from 90 days to 1 year after surgery.ResultsOverall, tramadol was prescribed at discharge in 11.0% of all THA/TKA cases. Of those, 26.9% and 73.1% received tramadol only or tramadol with another opioid, respectively. Chronic opioid use was observed in 5.4% of cases. After adjustment for relevant covariates, prescription of tramadol combined with another opioid at discharge was associated with lower odds of chronic opioid use comparing to prescription of other opioids (OR 0.69 CI 0.61 to 0.78).DiscussionAmong patients undergoing elective THA/TKA surgery and discharged with a prescription of opioids, we found that prescription of tramadol combined with another opioid was associated with lower odds of chronic opioid use. This finding must be considered in the context of the tramadol’s pharmacology, as well-described genetic differences in metabolism that can make it ineffective in many patients, while for patients with ultrarapid metabolism can cause drug–drug interactions and adverse events, including feelings of high and seizures.

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Section: Discussionsupporting

confidence: 77%

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty

Kiani

Poeran

Zhong

et al. 2022

Reg Anesth Pain Med

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“…8,9 However, recent studies caution regarding the use of tramadol due to association with a higher odds of novel persistent use after surgery and risk of additional, stronger opioid use. 11,12 Within our cohort, only 1 patient received a secondary prescription of oxycodone after being prescribed tramadol initially in the setting of severe bladder spasms. Otherwise, none of the patients received an opioid refill within the postoperative follow-up period through catheter removal.…”

Section: Discussionmentioning

confidence: 99%

“…10 Some studies have cautioned regarding tramadol use due to a higher odds of novel persistent use. 11,12 However, our goal in transitioning to tramadol was to reduce OMEs utilized in the postoperative setting.…”

mentioning

confidence: 99%

Postoperative Opioid Prescribing Following Outpatient Male Urethral Surgery: Evidence for Change

et al. 2023

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Introduction:Surgeons play a central role in the opioid epidemic. We aim to evaluate the efficacy of a standardized perioperative pain management pathway and postoperative opioid requirements in men undergoing outpatient anterior urethroplasty at our institution.Methods:Patients undergoing outpatient anterior urethroplasty by a single surgeon from August 2017 to January 2021 were prospectively followed. Standardized nonopioid pathways were implemented based on location (penile vs bulbar) and need for buccal mucosa graft. A practice change in October 2018 transitioned (1) from oxycodone to tramadol, a weak mu opioid receptor agonist, postoperatively and (2) from 0.25% bupivacaine to liposomal bupivacaine intraoperatively. Postoperative validated questionnaires included 72-hour pain level (Likert 0-10), pain management satisfaction (Likert 1-6), and opioid consumption.Results:A total of 116 eligible men underwent outpatient anterior urethroplasty during the study period. One-third of patients did not use opioids postoperatively, and nearly 78% of patients used ≤5 tablets. The median number of unused tablets was 8 (IQR 5-10). The only predictor for use of >5 tablets was preoperative opioid use (75% vs 25%, P < .01). Overall, patients using tramadol postoperatively reported higher satisfaction (6 vs 5, P < .01) and greater percentages of pain reduction (80% vs 50%, P < .01) compared to those using oxycodone.Conclusions:For opioid-naïve men, 5 tablets or less of opioid medication with a nonopioid care pathway provides satisfactory pain control following outpatient urethral surgery without excessive overprescribing of narcotic medication. Overall, multimodal pain pathways and perioperative patient counseling should be optimized to further limit postoperative opioid prescribing.

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“…Conversely, there are some studies suggesting that oxycodone and tramadol are more likely to predict persistence compared with other opioids such as tapentadol or other short-acting opioids. 33,51 Further comparative studies focusing on opioids prescribed during long-term opioid therapy are urgently needed, especially as these are one of the most commonly prescribed opioids globally. 25 Fourth, contrary to many guideline recommendations on maximising nonopioid interventions to support opioid taper, our findings showed that the prescription of NSAIDs and referral to medical specialists were inversely associated with successful taper.…”

Section: Discussionmentioning

confidence: 99%

Opioid characteristics and nonopioid interventions associated with successful opioid taper in patients with chronic noncancer pain

Jung,

Xia,

Ilomäki

et al. 2023

PAIN

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Current research indicates that tapering opioids may improve pain and function in patients with chronic noncancer pain. However, gaps in the literature remain regarding the choice of opioid and nonopioid interventions to support a successful taper. This study used an Australian primary care data set to identify a cohort of patients on long-term opioid therapy commencing opioid taper between January 2016 and September 2019. Using logistic regression analysis, we compared key clinical factors associated with differing taper outcomes. Of a total of 3371 patients who commenced taper, 1068 (31.7%) completed taper within 12 months. In the 3 months after commencement of taper, compared with those who did not complete taper, patients who successfully completed opioid taper were less likely to be prescribed buprenorphine (odds ratio [OR] 0.691; 95% CI: 0.530-0.901), fentanyl (OR, 0.429; 95% CI: 0.295-0.622), and long-acting (LA) opioids, including methadone (OR, 0.349; 95% CI: 0.157-0.774), oxycodone–naloxone (OR, 0.521; 95% CI: 0.407-0.669), and LA tapentadol (OR, 0.645; 95% CI: 0.461-0.902), but more likely to be prescribed codeine (OR, 1.308; 95% CI: 1.036-1.652). Compared with those who did not complete taper, patients who successfully tapered were less likely to be prescribed any formulations of oxycodone (short-acting [SA]: OR, 0.533; 95% CI: 0.422-0.672, LA: OR, 0.356; 95% CI: 0.240-0.530) and tramadol (SA: OR, 0.370; 95% CI: 0.218-0.628, LA: OR, 0.317; 95% CI: 0.234-0.428). The type of opioid prescribed in the months after commencement of taper seems to influence the taper outcomes. These findings may inform prospective studies on opioid taper.

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Persistent Opioid Usage After Urologic Intervention and the Impact of Tramadol

Cited by 5 publications

References 25 publications

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty

Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty

Postoperative Opioid Prescribing Following Outpatient Male Urethral Surgery: Evidence for Change

Opioid characteristics and nonopioid interventions associated with successful opioid taper in patients with chronic noncancer pain

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