WEDNESDAY, May 15, 2019 (Pharmacist's Briefing) -- Receipt of tramadol alone after surgery is associated with an increased risk for prolonged opioid use, similar to that seen with other short-acting opioids, according to a study published online May 14 in The BMJ.
Cornelius A. Thiels, D.O., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted an observational study of administrative claims data for opioid-naive patients undergoing elective surgery. The risk for persistent opioid use after discharge was examined for patients treated with tramadol alone versus other short-acting opioids. Overall, 357,884 of the 444,764 patients who met the inclusion criteria filled a discharge prescription for one or more opioids associated with one of 20 included operations.
The most commonly prescribed postoperative opioids were hydrocodone (53.0 percent of those filling a single opioid), short-acting oxycodone (37.5 percent), and tramadol (4 percent). The researchers found that the unadjusted risk for prolonged opioid use after surgery was 7.1, 1.0, and 0.5 percent, respectively, using three definitions of prolonged opioid use: additional opioid use, persistent opioid use, and the CONsortium to Study Opioid Risks and Trends (CONSORT) definition. Relative to individuals receiving other short-acting opioids, receipt of tramadol alone correlated with a 6 percent (adjusted risk ratio [aRR], 1.06; 95 percent confidence interval [CI], 1.00 to 1.13; P = 0.049), 47 percent (aRR, 1.47; 95 percent CI, 1.25 to 1.69; P < 0.001), and 41 percent (aRR, 1.41; 95 percent CI, 1.08 to 1.75; P = 0.013) increase in the risk for additional opioid use, persistent opioid use, and a CONSORT chronic opioid use episode, respectively.
"[These] data will force us to reevaluate our postsurgical prescribing guidelines," Thiels said in a statement. "And while tramadol may still be an acceptable option for some patients, our data [suggest] we should be as cautious with tramadol as we are with other short-acting opioids."