Factors associated with use of opioid rescue medication after surgery

Opioid exposure after surgery increases risk of persistent opioid use. Here, we characterize at-home use of opioid rescue medication during acute recovery after day surgery (N=270) in an opioid sparing context. The post-surgical pain management plan included non-steroidal anti-inflammatory drugs and up to 6 pills of 5mg oxycodone to be taken as needed. Thirty-two percent of patients reported having taken at least one dose of opioid analgesic 1-2 days after discharge. Opioid-takers differed from non-takers by prevalence of chronic pain (>3 months; 74% versus 48%), significantly higher pain and pain interference levels before and after surgery, received more opioid analgesics in the recovery room, and younger age. Logistic regressions confirmed a predictive role of these measures for rescue opioid medication use during acute recovery. Opioid-takers also had lower self-reported ability to cope with pain during acute recovery, and higher worry before surgery, but did not differ significantly on prior opioid or tobacco use.Long-term follow-up (4-30 months) data included self-reported opioid use, pain catastrophising and overall substance use from 143 patients (53%); no additional differences were identified from these materials. Acute pain levels were low at long term follow-up and only four patients (2%) reported using opioid analgesics.In conclusion, pre-operative chronic and acute pain, younger age and self-reported difficulty in coping with pain during recovery emerge as valuable predictors of opioid self-administration in the acute recovery phase and could be targets in patient centred care.