RT Journal Article
SR Electronic
T1 Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP 560
OP 565
DO 10.1136/rapm-2022-103486
VO 47
IS 9
A1 Sara Kiani
A1 Jashvant Poeran
A1 Haoyan Zhong
A1 Lauren A Wilson
A1 Lazaros Poultsides
A1 Jiabin Liu
A1 Stavros G Memtsoudis
YR 2022
UL http://rapm.bmj.com/content/47/9/560.abstract
AB Introduction We 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.Methods This 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.Results Overall, 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).Discussion Among 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.Data may be obtained from a third party and are not publicly available. The Truven MarketScan database is available for purchase.