The following is a summary of “Association of Reported Nonsteroidal Anti-Inflammatory Drug (NSAID) Adverse Drug Reactions With Opioid Prescribing After Total Joint Arthroplasty,” published in the June 2023 issue of Allergy and Clinical Immunology by Li et al.

Postoperative pain management is indicated for nonsteroidal anti-inflammatory medications (NSAIDs), but their use may be precluded by reports of adverse drug reactions (ADRs). Unknown is the impact of NSAID ADR labeling on opioid prescribing following total joint arthroplasty (TJA). This study evaluates the relationship between NSAID adverse drug reactions and postoperative opioid prescribing after TJA, a standard surgical procedure. Researchers conducted a retrospective cohort study on individuals who underwent total joint replacement (knee or hip) in a single hospital network between April 1, 2016, and December 31, 2019. 

The electronic health record contained demographic information, clinical and surgical characteristics, and prescription information. They examined the relationship between reported NSAID ADRs and postoperative opioid prescribing in a cohort matched by propensity score over a one-year follow-up period. About 9.6% of the cohort (n = 584/609) reported adverse effects of NSAID. In a sample matched by propensity score, NSAID ADR was associated with 41% higher odds of receiving opioid prescriptions 181 to 365 days after hospital discharge (95% CI: 13%-75%). At hospital discharge, over 98% of patients received an opioid prescription, with no difference in the aggregate median opioid dose prescribed by NSAID ADR status. 

However, more patients with NSAID ADRs (7.6% vs. 4.7%) were discharged with cumulative opioid doses of ≥750 morphine milligram equivalents (MME) (P =.000). At 181 to 365 days postoperatively, adverse reactions to NSAIDs were associated with an increased risk for prolonged opioid use. After TJA, patients with NSAID-associated adverse drug reactions received cumulative opioid doses of ≥750 MME more frequently. Clarification and evaluation of reported NSAID ADRs may be especially beneficial for surgical patients at high risk for receiving opioids for an extended duration.

Source: sciencedirect.com/science/article/abs/pii/S221321982300301X