Opioid Use In Patients Research Articles

Interventions to reduce opioid use for patients with chronic non-cancer pain in primary care settings: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from inception to December 28th 2021, and updated on Dec 14th 2023 for randomized controlled trials (RCTs) and cohort studies with no restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs and Newcastle Ottawa Scale for cohort studies. Primary outcomes included mean reduction in morphine equivalent daily dose (reported as mean differences [MDs] mg/day; 95% confidence intervals [95%CIs]) and/or opioid cessation proportion. Secondary outcomes were mean changes in pain severity (reported as standardized mean difference [SMDs]; 95%CIs) and (serious) adverse events. Meta-analyses were performed using random-effects models. We identified 3,826 records, of which five RCTs (953 participants) and five cohort studies (901 participants) were included. Overall, opioid dosage was significantly reduced in intervention groups compared to controls (MD: -28.63 mg/day, 95%CI: -39.77 to -17.49; I2 = 31.25%; eight studies). Subgroup analyses revealed significant opioid dose reductions with mindfulness (MD: -29.36 mg/day 95%CI: -40.55 to -18.17; I2 = 0.00%; two trials) and CBT-based multimodalities (MD: -41.68 mg/day; 95%CI: -58.47 to -24.89; I2 = 0.00%; two cohort studies), respectively, compared to usual care. No significant differences were observed in opioid cessation (Odds ratio: 1.10, 95%CI: -0.48 to 2.67, I2 = 58.59%; two trials) or pain severity (SMD: -0.13, 95%CI: -0.37 to 0.11; I2 = 33.51%; three trials). Adverse events were infrequently examined, with withdrawal symptoms commonly reported. The studied interventions were effective in reducing opioid dosage for people with CNCP in primary care. They highlighted the importance of multidisciplinary collaboration. Large-scale RCTs measuring the long-term effects and cost of these interventions are needed before their implementation.

Retrospective analysis of opioid use in patients with and without cryoneurolysis prior to total knee arthroplasty: a comparison cohort study

Introduction Routine usage of opioids to manage pain in the post-operative period is commonplace following many orthopaedic procedures. As the trends of opioid abuse and addiction have been primarily linked to an increase in opioid prescriptions, more attention has been focused on reducing opioid prescriptions by managing postoperative pain via alternative methods. The objective of this study was to determine if cryoneurolysis within three months prior to total knee arthroplasty (TKA) resulted in reduced opioid consumption postoperatively. Materials and Methods An IRB approved retrospective review of 183 patients who underwent primary TKA between August 2022 and February 2023 was conducted. The primary outcome was postoperative opioid usage was compared between patients who received cryoneurolysis within three months prior to TKA compared with patients who did not receive cryoneurolysis preoperatively. Secondary outcomes included postoperative knee range of motion (ROM) and referral to physical therapy. Results No statistically significant difference was observed in postoperative opioid consumption for patients who underwent cryoneurolysis prior to TKA compared with patients who did not undergo cryoneurolysis prior to surgery. Discussion Although cryoneurolysis within three months prior to TKA failed to produce a statistically significant decrease in postoperative opioid consumption, the lead author’s preoperative treatment pathway did result in overall reduction in opioid consumption compared to previously published studies. Conclusion The results of this study suggest that cryoneurolysis within three months prior to TKA does not reduce patient postoperative opioid consumption.

Managing opioids and mitigating opioid risks in patients with cancer: An environmental scan of the attitudes, confidence, and practices of ambulatory, community and hospital pharmacists practicing in Canada.

Canada is in the midst of an overdose crisis. The use of prescription opioids in Canada has increased steadily over the past two decades, with stark increases in opioid-induced respiratory depression and related deaths. Opioids are the mainstay of treatment for cancer-related pain. Patients with cancer are not immune to the risks associated with opioid use but are underrepresented in available literature outlining risk mitigation strategies. Pharmacists are ideally placed to employ opioid risk mitigation practices to support safe and effective opioid use for patients with cancer-related pain. However, the current attitudes, confidence, and safety practices of pharmacists around how to best support these patients are not known. This study was a descriptive environmental scan of pharmacists who provide direct patient care in Canada. An electronic questionnaire was built using the web based Opinio software. It was distributed via email by several provincial and national pharmacy organizations and online platforms. The questionnaire consisted of Likert-scale and open-ended questions and was open to participants for a 6-week period from February 12th to March 23rd, 2020. Analysis was conducted using descriptive statistics and qualitative content analysis. Eighty-one responses from pharmacists in nine provinces were included in the analysis. Respondents endorsed limited and varied practices when caring for patients receiving opioids for cancer-related pain. Further, they demonstrated wide ranging confidence and attitudes regarding opioid risk mitigation practices and beliefs. Less than 50% of pharmacists were aware of resources available for their patients with non-medical opioid use, and/or patients at high risk of opioid-induced respiratory depression. Education, resources, and communication were the most commonly reported perceived facilitators and barriers to resource use. Pharmacists in Canada report employing opioid risk mitigation practices with low and varied frequency when caring for patients receiving opioids for cancer-related pain. They endorsed varied confidence and limited awareness of available provider and patient resources. These findings may help inform the development of new education models and evidence-based guidelines. New education models and evidence-based guidelines will support pharmacists in their pharmaceutical care of this vulnerable patient population, ultimately aiming to improve patient outcomes.

High-risk use of prescription opioids among patients treated for alcohol problems in New York State. A repeated cross-sectional study, 2005–2018

BackgroundPatients with alcohol use disorder (AUD) and high-risk opioid use are at risk of serious complications. The purpose of this study was to estimate the prevalence of and factors associated with high-risk opioid use in patients with an alcohol use problem from 2005 to 2018. MethodsThis repeated cross-sectional study analyzed data from first admissions for alcohol treatment (2005–2018) to the NYS Office of Addiction Services and Supports merged with Medicaid Claims Data. High-risk opioid use was defined as opioid dose ≥50 morphine mg equivalents (MME) per day; opioid prescriptions overlapping ≥7 days; opioids for chronic pain >90 days or opioids for acute pain >7 days. ResultsPatients receiving ≥50 MME increased from 690 to 3226 from 2005 to 2010; then decreased to 2330 in 2018. From 2005–2011, patients with opioid prescriptions overlapping ≥7 days increased from 226 to 1594 then decreased to 892 in 2018. From 2005–2010, opioid use >7 days for acute pain increased from 133 to 970 and plateaued after 2010. From 2005–2018, patients who received opioids >90 days for chronic pain trended from 186 to 1655. White patients, females, age 36–55, patients with chronic and acute pain diagnoses had the highest rates of high-risk use. ConclusionsThe prevalence of high-risk opioid use in patients with alcohol use problems increased from 2005 to 2011, and generally decreased after 2010. However, prevalence of opioids >90 days for chronic pain trended up from 2005 to 2018. High-risk opioid use among patients with AUD emphasizes the need to develop interventional strategies to improve patient care.

A Randomized Trial Evaluating Acceptance and Commitment Therapy and Smart Phone Care Management Application to Augment Buprenorphine Therapy for Opioid Use and Chronic Pain.

There is high comorbidity of opioid use disorder (OUD) and chronic pain (CP), which is often addressed by prescribing buprenorphine (BUP). While BUP is effective in preventing overdose, it does not address the psychological aspects of OUD and CP comorbidity and treatment retention rates are as low as 50%. The Virtual Opioid use disorder Integrated Chronic Pain Treatment (VOICE) study (NCT05039554) is a novel effectiveness-implementation trial to test a 12-week virtual group Acceptance and Commitment Therapy (ACT) protocol and a care management smartphone application (app; Valera Health) on pain and opioid use in patients with OUD and CP receiving BUP. Using a 2 × 2 factorial design, participants (expected N = 280) are randomized into: ACT, Valera app, ACT + Valera, or Treatment as Usual arm. This study is taking place in the Bronx, NY, a racially/ethnically diverse community that faces numerous socioeconomic stressors and is one of the nation's epicenters of the opioid epidemic. We created a culturally responsive ACT group protocol, and Valera psychoeducational material. Outcome measures include NIH HEAL Common Data Elements and ACT and Valera-specific measures. We are conducting a novel 2 × 2 trial investigating augmenting BUP treatment with ACT and Valera, with the goal that improved mental health and access to care will result in decreased and opioid use and pain interference.

Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial.

Few studies report outcomes for enhanced recovery pathways in ambulatory anorectal surgery. We hypothesize that an ambulatory anorectal enhanced recovery pathway with multimodal analgesia can reduce postoperative opioid use. To compare postoperative opioid use in patients undergoing ambulatory anorectal surgery who receive multimodal analgesia vs. standard of care without multimodal analgesia. A prospective randomized trial of patients undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Urban teaching hospital. Adults aged 18 to 70 undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Multimodal enhanced recovery pathway including pre- and postoperative non-opioid analgesia with oral acetaminophen, gabapentin and ketolorac. Primary endpoint was oral opioid use during the first postoperative week. Secondary endpoints included maximum pain and nausea scores, adverse events and emergency room or hospital admissions during the first 30 days postoperatively. Of the 109 enrolled patients, 20 were lost to follow-up. The remaining 89 patients had a median age of 38 (range, 20-67) years and included 41 (46%) females. There were no significant differences between the enhanced recovery protocol (Arm E) and non-enhanced recovery protocol (Arm NE) groups in terms of preoperative and surgical characteristics. The study primary endpoint, oral MME use during the first week, was significantly higher among patients in the NE arm (79 mg; range, 0-600) than patients in the E arm (8 mg; range, 0-390) (p = 0.002). On subgroup analysis, both fistula and hemorrhoid surgery patients assigned to the NE arm took significantly higher oral MME in the first week than patients in the E arm. There was no significant difference in secondary endpoints. Patients and providers were not blinded. Our findings are limited to hemorrhoid and fistula surgery and may not be applicable to other anorectal procedures. Enhanced recovery protocols including multimodal analgesia should be used in elective anal fistula and hemorrhoid surgery to decrease postoperative opioid use. See Video Abstract . ClinicalTrials.gov ID NCT03738904.

Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

BackgroundA bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.MethodsIn...

The effect of epidural steroid injections for the management of spinal malignancy-related pain.

e24052 Background: Spinal malignancy-related pain is common in cancer patients. There are several treatment options from systemic steroid injection to surgical treatment. Epidural steroid injection (ESI) is one of commonly performed treatment. The purpose of this study is to assess the effect of ESI in spinal malignancy-related pain. Methods: We retrospectively reviewed our cases who was diagnosed with spinal metastatic cancer, and received ESI from January 2021 to December 2022. The primary outcome was pain intensity (Visual Analogue Scale score, 0-10) at baseline, 1, 3 and 6 months after ESI. Patients with a pain reduction of more than 50% at 1 month after ESI were classified as success group (S), and others were classified as failure group (F). The secondary outcomes were change of MEDD (morphine equivalent daily dose, mg/day) at same time points. Also, each patient’s demographic data, ECOG, history of previous radiotherapy, and survival duration following ESI. Results: Totally 135 patients were enrolled, and 80 patients were analyzed. Of the 80 patients, 47 and 33 patients were classified into the S and F group, respectively (Table 1). Patients who had previous radiotherapy was 68.1% in S group, but only 48.5% in F group (p = 0.04). The 80% of group S survived over 6 months, compared to 39% of group F (p < 0.001). There were significant differences in VAS scores between S and F groups at all-time points during the follow-up period (P < 0.001) and MEDD was significantly lower in the S group at 1 (p = 0.02) and 3 months (p < 0.01). Conclusions: This study demonstrates that ESI effectively reduce pain and opioid use in patients with spinal malignancy-related pain. Given the observed survival periods, it can be inferred that earlier intervention with ESI is more likely to yield beneficial outcomes. [Table: see text]

Buprenorphine Low-Dose Initiation to Decrease Total Opioid Use in Patients with Cancer and Non-Cancer-Related Pain

Buprenorphine Low-Dose Initiation to Decrease Total Opioid Use in Patients with Cancer and Non-Cancer-Related Pain

Long-Term Reductions in Opioid Medication Use After Spinal Stimulation: A Claims Analysis Among Commercially-Insured Population.

Chronic, non-cancer pain significantly and negatively impacts patient quality of life. Neuromodulation is a major component of multi-modal interdisciplinary approaches to chronic pain management, which includes opioid and nonopioid medications. In randomized controlled trials, spinal cord stimulation (SCS) has been shown to reduce pain and decrease short-term opioid use for patients. This study sought to evaluate the effect of SCS on longer term opioid and non-opioid pain medication usage among patients over ≥3 years of follow-up. Claims analysis was conducted using the Merative™ MarketScan® Commercial Database. Patients aged ≥18 who initiated SCS between 1/1/2010 and 3/31/2021 with ≥1 year of baseline data and ≥3 years of follow-up data were included. Opioid discontinuation, daily dose (DD) reduction, proportion of days covered (PDC), concomitant co-medication with benzodiazepines and/or gabapentinoids, and polypharmacy were evaluated during the baseline and follow-up periods. Adjusted logistic regression was used to evaluate the impact of baseline dosages on discontinuation and dose reduction. During follow-up, 60% of 2,669 SCS patients either discontinued opioid use or reduced opioid DD by at least 20% from baseline; another 15% reduced DD by 1-19%. Logistic regression showed patients with higher baseline dosages were less likely to discontinue opioids completely (odds ratio[OR] 95% confidence intervals[CI]: 0.31[0.18,0.54]) but more likely to reduce their daily dose (OR[CI]: 7.14[4.00,12.73], p<0.001). Mean PDC with opioids decreased from 0.58 (210 of 365 days) at baseline to 0.51 at year 3 (p<0.001). With SCS, co-medication with benzodiazepines decreased from 47.3% at baseline to 30.3% at year 3, co-medication with gabapentinoids reduced from 58.6% to 42.2%, and polypharmacy dropped from 15.6% to 9.6% (all p<0.001). Approximately three-quarters of patients who received SCS therapy either discontinued or reduced systemic opioid use over the study period. SCS could assist in reducing long-term reliance on opioids and other pain medications to treat chronic non-cancer pain.

Decreasing Perioperative Opiate Use During Pancreaticoduodenectomy Using Transversus Abdominus Plane Blocks: A Review of the Literature.

Pancreatoduodenectomy is a highly complex surgical procedure associated with high postoperative morbidity and mortality. Treatment of postoperative pain is crucial to preventing chronic pain and further complications. Opioids are the leading treatment modality for acute postoperative pain for all surgical procedures in the US, contributing to the opioid epidemic, a crisis causing death and lifelong impairment in many patients. Multimodal analgesia techniques, such as the transversus abdominis plane (TAP) block, are suggested to reduce perioperative opioid usage. This exploratory literature review aims to investigate the use of TAP block in postoperative pain and opioid use in patients undergoing pancreatoduodenectomy. A search strategy developed from Cochrane best practice recommendations was applied to a comprehensive search of PubMed, Scopus, and PsycINFO databases, yielding three articles of relevance in patients having pancreatic surgery. Previous research demonstrates TAP block efficacy in decreasing opiate consumption after major abdominal surgery; however, there is a paucity of data regarding opioid consumption in pancreatoduodenectomy patients. Research in relation to TAP block analgesia is varied given the variety of approaches, techniques, and timing of the TAP block procedure. Future research should seek to elucidate the role of TAP blocks in reducing postoperative pain and opioid consumption in pancreatoduodenectomy patients.

Time trends in opioid use for patients undergoing hip fracture surgery in 1997-2018: A Danish population-based cohort study.

Although opioids are a mainstay for perioperative pain management in hip fracture patients, no studies have described changes in opioid use over the last two decades. The aim of this study was to describe time trends in opioid use in a population-based cohort of patients undergoing a first-time hip fracture surgery during 1997-2018. Opioid-naïve hip fracture patients >55 years old were identified in Danish medical databases (n = 115,962). By 2-year calendar periods, we calculated prevalence rates (PR) of opioid use in the four quarters after surgery (Q1-Q4). Corresponding prevalence rate ratios (PRR) with 1997-1998 as a reference were estimated with 95% confidence intervals. Further, we calculated the median morphine milligram equivalents (MME) for each quarter. For Q1, the PR of opioid use increased from 29% in 1997-1998 to 78% in 2017-2018 corresponding to a PRR of 2.7 (2.6-2.8). For Q4, the PR was 15% in 1997-1998, peaked in 2003-2004 and then decreased, but stayed high at 13% in 2017-2018. The median MME did not increase when comparing 2017-2018 with 1997-1998, irrespective of the quarter. Tramadol was most frequently used in 1997-1998 shifting to oxycodone in 2017-2018. The PRs of opioid use in Q1 after surgery increased substantially from 1997 to 2018, but this did not translate into increased opioid use up to 1 year after hip fracture surgery or higher dosage. Our findings underline the importance of sustained focus on opioid tapering, dosage and use of opioids with the lowest potential for addiction and other adverse events. Overall, opioid use in Q1 after hip fracture surgery increased 2.7 times from 1997 to 2018, but the doses and opioid use up to 1 year after surgery remained stable. Compared to elderly, younger patients were more likely to use opioid in Q1, while the tendency was opposite in Q2-Q4. The most used opioid type changed from tramadol to oxycodone. Our findings underline the importance of personalized opioid tapering and doses, and use of opioids with the lowest potential for addiction and other adverse events.

Association Between Intra- and Postoperative Opioids in Opioid-Naïve Patients in Thoracic Surgery

BackgroundAs the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed. We examined whether intraoperative opioid administration was associated with greater postoperative opioid use prior to discharge in opioid-naïve patients undergoing thoracic surgery. Further, we sought to determine predictors of higher intra- and postoperative opioid use including demographic and patient factors and hospital. MethodsData on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast United States. All patients and data on total intraoperative and postoperative (prior to discharge) opioid administration were included. A total of 126 patient encounters were analyzed. ResultsIncreased intraoperative morphine milligram equivalent was associated with increased postoperative administration, where each unit increase in intraoperative morphine milligram equivalent was associated with 0.57 increased units in postoperative use (B = 0.57; 95% CI, 0.29-0.87, P < .0003), controlling for patient race, sex, age, weight, Elixhauser comorbidity score, and hospital. Younger age (P < .002), comorbidity (P < .054), and weight (P < .026) were associated with higher intra- and postoperative opioid use, but race (P < .320) and sex (P < .980) were not associated with opioid administration. ConclusionsIntraoperative opioid use had a significant impact on postoperative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race, and sex. Substantial variation in both intra- and postoperative opioid administration was noted.

The impact of preoperative benzodiazepine use on postoperative opioid use in total shoulder arthroplasty

As the rate of total shoulder arthroplasty (TSA) and preoperative benzodiazepine use rise, there is an increased need to understand the impact of preoperative benzodiazepine use on postoperative opioid consumption following TSA, especially amid the current opioid epidemic. The relationship between preoperative benzodiazepine use and chronic opioid use postoperatively has been well described following other orthopedic procedures; however, the impact on patients undergoing TSA remains unclear. This study aims to identify the impact of preoperative benzodiazepine use on opioid use following TSA. A retrospective chart review of 4488 patients undergoing primary TSA (Current Procedural Terminology code 23472) at a single institution from 2014 to 2022 was performed. Patient demographics, surgical variables, comorbidities, Distressed Communities Index (DCI), and clinical outcomes, including readmission and revision, were collected. The Charlson Comorbidity Index (CCI) was used to assess preoperative health status. Opioid use in morphine milligram equivalents (MMEs) and benzodiazepine use were also recorded using the Prescription Drug Monitoring Program Database. Opioid use was collected at 30-, 60-, and 90-day intervals both before and after each patient's date of surgery. Statistical analysis included stepwise logistic regression to identify variables independently affecting benzodiazepine use pre- and postoperatively. Overall, 16% of patients used benzodiazepines within 90 days before their date of surgery. Of those patients, 46.4% were also using preoperative opioids, compared with just 30.0% of patients who were benzodiazepine-naïve (P<.001). Preoperative benzodiazepine use was also associated with increased pre- and postoperative total opioid use in MMEs and the number of opioid prescriptions across all time points when compared to benzodiazepine-naïve patients (P<.001). Furthermore, 37.4% of preoperative benzodiazepine users went on to prolonged opioid use (filled prescriptions >30 days after surgery) compared to 19.0% of those who were benzodiazepine-naïve (P<.001). This study demonstrates a significant association between preoperative benzodiazepine use and increased and prolonged opioid use following TSA. Further exploration of risk factors contributing to preoperative benzodiazepine use may help to reduce overall opioid use in patients undergoing TSA.

Does the type of lower extremity fracture affect long-term opioid usage? A meta-analysis.

Patients recovering from musculoskeletal trauma have a heightened risk of opioid dependence and misuse, as these medications are typically required for pain management. The purpose of this meta-analysis was to examine the association between fracture type and chronic opioid use following fracture fixation in patients who sustain lower extremity trauma. A meta-analysis was performed using PubMed and Web of Science to identify articles reporting chronic opioid use in patients recovering from surgery for lower extremity fractures. 732 articles were identified using keyword and MeSH search functions, and 9 met selection criteria. Studies were included in the final analysis if they reported the number of patients who remained on opioids 6 months after surgery for a specific lower extremity fracture (chronic usage). Logistic regressions and descriptive analyses were performed to determine the rate of chronic opioid use within each fracture type and if age, year, country of origin of study, or pre-admission opioid use influenced chronic opioid use following surgery. Bicondylar and unicondylar tibial-plateau fractures had the largest percentage of patients that become chronic opioid users (29.7-35.2%), followed by hip (27.8%), ankle (19.7%), femoral-shaft (18.5%), pilon (17.2%), tibial-shaft (13.8%), and simple ankle fractures (2.8-4.7%).Most opioid-naive samples had significantly lower rates of chronic opioid use after surgery (2-9%, 95% CI) when compared to samples that allowed pre-admission opioid use (13-50%, 95% CI). There were no significant associations between post-operative chronic opioid use and age, year, or country of origin of study. Patients with lower extremity fractures have substantial risk of becoming chronic opioid users. Even the lowest rates of chronic opioid use identified in this meta-analysis are higher than those in the general population. It is important that orthopedic surgeons tailor pain-management protocols to decrease opioid usage after lower extremity trauma.

The Effect of Kyphoplasty on Opioid Use in Patients With Vertebral Compression Fractures

The Effect of Kyphoplasty on Opioid Use in Patients With Vertebral Compression Fractures

Characteristics and outcomes of peripheral neuropathic pain patients with repeated applications of high-concentration capsaicin cutaneous patch: Results of a retrospective chart review in Germany.

The aim of this study was to evaluate patient characteristics, concomitant analgesic medication, and pain intensity in a real-world setting in Germany, focusing on the repeated application of high-concentration capsaicin patch (HCCP) for neuropathic pain. Data were collected from electronic medical records of patients who received at least two HCCP treatments between January 2011 and July 2022. Subgroup analyses were performed based on the number of HCCP treatments, age groups, and specific neuropathic pain conditions. The study was conducted at an outpatient pain center in Wiesbaden, Germany. The study included 97 patients, primarily diagnosed with neuropathic back pain, postoperative or post-traumatic neuropathic pain, and postherpetic neuralgia. The daily dose of concomitant medications (eg, opioids and anticonvulsants) at the start of capsaicin therapy was compared with the average within 2 years of capsaicin therapy. The last observation carried forward method was used if HCCP treatment was discontinued before the end of the 2-year period. The majority of patients received concomitant medications, with opioids, anticonvulsants, and antidepressants being the most common. The average daily morphine equivalent dose decreased significantly during HCCP treatment. Pain intensity at baseline was generally high, but substantial improvements were observed in patients who received at least three HCCP applications. This study provides evidence for the effectiveness of HCCP treatment in reducing pain intensity and concomitant opioid use in patients with neuropathic pain. Further research is needed to explore the long-term outcomes and optimal treatment regimens for different patient populations.

(041) Pre-Operative Bilateral Pudendal Nerve Blocks can Reduce Opioid Utilization for Patients Undergoing Urologic Prosthetic Procedures

Abstract Introduction Opioid related overdoses and deaths have been increasing in recent decades, and recent studies have shown that even short courses of opioids can result in dependence and misuse. Urologic prosthetic procedures can be painful, and historically pain management has been predominantly through opioid-based analgesia. Multimodal pain management plans have been shown to help reduce exposure to opioids, and these include local nerve blockade. Objective Our study aims to assess the efficacy of bilateral pudendal nerve block in post-operative pain management and reduction of opioid use. Methods We conducted a retrospective review of all patients undergoing urologic prosthetic surgeries at a single Canadian institution between September 2020 and June 2023. Prosthetic surgeries included inflatable penile prosthesis (IPP) and artificial urethral sphincter (AUS) implants and explantation/reimplantation, but patients were only included once during the study period. Patients with chronic pain or missing pain data were excluded. Patients received bilateral pudendal nerve blocks at the discretion of the surgeon as a practice change starting in 2021 and compared to a control group (no blocks). Pain was assessed by the nursing care team using an analogue rating scale (out of 10), and all opioid and non-opioid pain medications were blindly recorded by nursing as their part of their usual documentation. Opioid utilization was converted to oral morphine equivalents (OMEs). Primary outcome was OMEs utilization in the post-operative period while in hospital, with a secondary of overall pain scores. Data was analysed using two-sample t-tests, and significance set to a p-value of 0.05. Results Our study included a total of 134 patients, with 59 patients receiving preoperative bilateral pudendal nerve blocks (54 IPP, 5 AUS), and 75 patients receiving the standard protocol (31 IPP, 44 AUS). The median age of patients receiving pudendal nerve blocks was 62.51 compared to the control group median age of 67.81. (p&amp;lt;0.05). There was no difference in ages in sub-analysis of IPP and AUS cohorts. Sub-analysis of the AUS cohort demonstrated a lower median pain score immediately post-op for those receiving blocks compared to control (0.8 vs. 2.73 respectively, p&amp;lt;0.05), with no difference in pain scores otherwise. AUS patients with pudendal nerve blocks consumed significantly less OMEs on day of surgery (median 0 vs. 6.75 OMEs, p&amp;lt;0.05). The IPP cohort with pudendal nerve blocks had no difference in pain scores compared to control, but consumed significantly less OMEs on day of surgery (9.06 vs. 12.56 OMEs respectively, p&amp;lt;0.05) and on post-operative day one (2.99 vs. 7.30 OMEs respectively, p&amp;lt;0.05). Conclusions Preoperative bilateral pudendal nerve blocks appear to reduce post-operative opioid use for patients undergoing urologic prosthetic surgery. Regular use of pudendal nerve blocks for patients undergoing prosthetic and pelvic surgeries may be an efficient means to reduce patient exposure to opioids. Bilateral pudendal nerve blockade for all genital and pelvic surgeries may be an effective opioid harm reduction strategy and warrants further investigation and patient satisfaction outcomes. Disclosure No.

Incidence of persistent opioid use following traumatic injury

IntroductionMajor traumatic injuries are a known risk factor for persistent opioid use, but data describing the relationship between specific traumatic injuries and opioid use is lacking.MethodsWe used insurance claims data...

Understanding the effects of nutrition and mental health conditions for patients with opioid use disorder (OUD).

The ravaging effects of the opioid epidemic have affected our communities locally and nationally and are multifaceted in their cause and treatment. It is imperative to locate multiple modalities of treatment options and care for patients with opioid use disorder (OUD) including developing healthy nutrition habits and addressing mental health concerns. Understanding patient perceptions of their personal nutrition habits and mental health status is imperative to providing holistic care in the OUD patient population. An anonymous 31-question Likert-scale and multiple-choice survey was administered to patients with an International Classification of Disease (ICD-10) code in their electronic medical record of OUD (N = 124). χ2 and Fisher's exact test where appropriate were performed to determine the demographics of survey participants who acknowledged history of OUD compared to those who did not acknowledge a history of OUD. Log-binomial models were used to generate adjusted prevalence ratios. Of the 117 patients identified using ICD-10 codes from their medical records as having OUD, only 63 patients acknowledged having a history of OUD, while 54 patients did not. A univariate analysis showed differences in marital status for patients with a self-identified history of OUD. They were also more likely to not be married (divorced or single) (p < 0.01). Patients also tended to be younger than 50 years of age (p < 0.01) and non-White (p < 0.01). There were no differences seen for patients with a history of OUD in the categories of employment (p = 0.31) status or sex (p = 0.51). Patients who acknowledged a history of OUD were significantly more likely to understand the relationship between a healthy diet and reducing the intensity of opioid cravings (p = 0.01) and more likely to consider using nutrition to help combat opioid cravings (p = 0.01). There were no significant differences in overall health or the use of supplements as a part of opioid use treatment. Significant differences were found between those acknowledging a history of OUD having higher rates of depression (p = 0.02) and anxiety (p = 0.02) treatment, despite there not being differences in condition rates for these two conditions (depression, p = 0.08; anxiety, p = 0.27) between the groups. Patients with patient-confirmed OUD were more likely to receive medication treatment (p = 0.03) than those without this acknowledgment. A similar disease burden of anxiety and depression existed for patients acknowledging OUD as opposed to patients denying OUD. However, significant differences existed between these groups in medication treatment, with those acknowledging OUD having higher rates of being treated for both depression and anxiety. Understanding a patient's mental health condition(s) can be impactful for the treatment of OUD. Multifaceted treatment options should include addressing nutritional deficiencies that impact cravings and long-term healing for patients. Nutrition and mental health are key parts of a multifaceted treatment modality for patients dealing with OUD. Assisting patients in treatment for depression and anxiety as well as nutrition can change the trajectory of a patient's opioid use recovery.