Trends in non-opioid analgesic use following major abdominal surgery: a retrospective single-center cohort study

Non-opioid analgesics are essential in multimodal analgesia and opioid-sparing strategies; however, their clinical use remains suboptimal. This study aimed to investigate trends in perioperative non-opioid analgesic administration and associated adverse effects in patients undergoing major abdominal surgery at a tertiary hospital.

Prescription data for acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) were retrospectively collected from January 2020 to December 2024. Actual administration was assessed at three perioperative phases: preemptive, intraoperative, and postoperative (postoperative day [POD] 0-3). The study period was divided into 20 quarters. Trends of administration rates over time were analyzed using a linear regression model. Postoperative drug-induced liver injury (DILI) and acute kidney injury (AKI) were evaluated, and Poisson regression was applied to adjust for covariates within each quarter.

A total of 24,688 surgical cases involving 24,084 patients were analyzed. The administration rate of acetaminophen exhibited a significant upward trend throughout the study from the preemptive phase to POD 2. NSAID administration increased significantly, mainly up to POD 1, though the overall magnitude of the increase was modest. Postoperatively, less than 5% of patients received both analgesic classes concurrently. The analgesic administration rate was not significantly associated with DILI or AKI.

The use of non-opioid analgesics for major abdominal surgery has increased significantly over the past 5 years. However, their overall utilization, particularly postoperatively, remains limited. Further efforts are required to promote their broader integration into clinical practice.