The Influence of Profession, Experience and Geographical Region on Intra- and Postoperative Opioid Practice in...

Clinicians often administer opioids to manage postoperative pain, but with considerable variation in chosen opioid and dosing strategies. This post hoc analysis of a Danish nationwide survey assessed how profession, length of experience, and geographical region impact dosing in the intraoperative phase (end of surgery) and the postoperative phase (PACU) for postoperative control.

A 37-item online survey on opioid practice amongst anaesthesia personnel in Denmark (5 February-30 April 2024). Regression analyses compared intravenous morphine equivalent doses (MEQ) in eight clinical cases for three provider characteristics: profession (physician/nurse), length of experience (> < 10 years) and geographical region (five regions). We predefined differences ≥ 0.03 mg/kg MEQ as clinically relevant. We qualitatively described group differences in perioperative factors guiding dose adjustments, defining differences ≥ 10% as relevant.

The overall response rate was 48% (2025/4187). In four intraoperative clinical cases, anaesthesiologists administered on average 0.04 mg/kg MEQ less than nurse anaesthetists (95% CI: 0.03 to 0.04, p < 0.001), considered clinically relevant. Respondents with short working experience (< 10 years) administered 0.01 mg/kg MEQ less (95% CI: 0.00 to 0.02, p = 0.001). Respondents in the North Denmark Region administered 0.07 mg/kg MEQ more than the national average of 0.32 mg/kg MEQ (p < 0.001), considered clinically relevant. In postoperative clinical cases, significant dosing differences between short versus long working experience were not considered clinically relevant. Clinically relevant differences in dose-adjusting factors existed between professions (preoperative opioid use, age, body weight, alcohol use, chronic pain, and ASA classification) and regions (chronic pain, body weight, preoperative opioid use, ASA classification, sedation, BMI, and nausea).

Clinical profession and regional background contribute to variation in opioid dosing strategies. Nurse anaesthetists and respondents from the North Denmark Region administered significantly and clinically relevant higher doses of opioids. Clinically relevant differences existed between professions and regions regarding opioid dose-adjusting factors.

This secondary analysis of survey results from Denmark regarding opioid choices and dosing preferences for post-surgical analgesia focused on professional categories and regions within Denmark. Some apparent dosing preference differences were described between professional groups and also between regions.