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Analgesic consumption after major lower extremity amputation - a Danish nationwide register-based study from
Jeppe Marinus Mortensen1,2, Anna Trier Heiberg Brix1,2, Kristine Bollerup Arndt3
1Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Objectives:
Persistent pain after major lower extremity amputation (MLEA) is common. This study aimed to investigate opioid and non-opioid analgesic consumption, defined by drug group, one year before and after MLEA and to investigate risk factors for postoperative opioid use.
Method:
Through the Danish National Patient Registry, we identified 7,012 patients, ≥50 years, alive one year postoperatively, with first-time MLEA performed in 2010-2021, divided in below-knee (BKA) and above-knee amputations (AKA). Prescription redemptions were used as a proxy for analgesic use, which was analysed by drug class: Opioids, and non-opioids: NSAIDs, paracetamol, anticonvulsants, antidepressants, and other. Long-term opioid users were defined as patients with ≥1 redeemed opioid prescription in all four quarters post-amputation.
Results:
Opioid-use peaked in the quarter before MLEA (-Q1) at 93 % (CI 92-93 %) and remained higher one year after (37 %, CI 36-38 %) compared with one year before (25 %, CI 24-26 %). Long-term opioid use rose from 19 % (CI 18-20 %) to 28 % (CI 27-29 %). Paracetamol (93 %, CI 92-93 %), anticonvulsants (58 %, CI 57-60 %), and antidepressants (39 %, CI 38-40 %) peaked at - Q1, declining but exceeding baseline at one year. Female sex (OR 1.3, CI 1.2-1.5), AKA level (OR 1.5, CI 1.5-1.7), and long-term "other" analgesic use (OR 2.2, CI 1.6-3.0) were risk factors for new long-term opioid use.
Conclusion:
In conclusion, the use of opioids and non-opioid analgesics increased before MLEA, peaking before surgery. Postoperatively, the use declined but remained higher than in the pre-amputation year.
