Association Between Postoperative Methocarbamol and Postoperative Pain Opioid Dose Requirements: A Retrospective Cohort Study.
Journal
The Clinical journal of pain
ISSN: 1536-5409
Titre abrégé: Clin J Pain
Pays: United States
ID NLM: 8507389
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
received:
22
06
2022
accepted:
26
05
2023
medline:
11
8
2023
pubmed:
7
6
2023
entrez:
7
6
2023
Statut:
epublish
Résumé
We tested the hypothesis that patients who received methocarbamol postoperatively experience less severe pain and require smaller doses of opioids than those who did not receive methocarbamol. This is a retrospective cohort study of patients undergoing surgery involving the musculoskeletal system. Of 9089 patients, 704 received methocarbamol during 48 hours postoperatively, while 8385 did not receive methocarbamol. The patients who received methocarbamol postoperatively and the patients who did not receive methocarbamol were compared on the time-weighted average (TWA) pain score and opioid dose requirements in morphine milligram equivalents (MME) during the first 48 hours postoperatively, using propensity score-weighted regression models to adjusting for preoperative and intraoperative covariates. Postoperative 48-hour TWA pain scores were 5.5±1.7 (mean±SD), and 4.3±2.1 for methocarbamol and non-methocarbamol patients. Postoperative 48-hour opioid dose requirements in MME were 276 [170-347] (median [interquartile range (IQR)]) mg, and 190 [60-248] mg for methocarbamol and non-methocarbamol patients. In propensity score-weighted regression models, receiving methocarbamol postoperatively was associated with 0.97-point higher postoperative TWA pain score (95% CI, 0.83-1.11; P <0.001), and 93.6-MME higher postoperative opioid dose requirements (95% CI, 79.9 to 107.4; P <0.001), compared with not receiving methocarbamol postoperatively. Postoperative methocarbamol was associated with significantly higher acute postoperative pain burden and opioid dose requirements. Although the results of the study are influenced by residual confounding, they suggest a limited-if any-benefit of methocarbamol as an adjunct of postoperative pain management.
Identifiants
pubmed: 37284760
doi: 10.1097/AJP.0000000000001137
pii: 00002508-990000000-00099
doi:
Substances chimiques
Analgesics, Opioid
0
Methocarbamol
125OD7737X
MME
78185-58-7
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
452-457Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Gan TJ, Habib AS, Miller TE, et al. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30:149–160.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–1625.
Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172:425–430.
Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 2001;26:257–264.
See S, Ginzburg R. Skeletal muscle relaxants. Pharmacotherapy. 2008;28:207–213.
Looke TD, Kluth CT. Effect of preoperative intravenous methocarbamol and intravenous acetaminophen on opioid use after primary total hip and knee replacement. Orthopedics. 2013;36:25–32.
Hidalgo DA, Pusic AL. The role of methocarbamol and intercostal nerve blocks for pain management in breast augmentation. Aesthetic Surg J. 2005;25:571–575.
Deloney LP, Smith Condeni M, Carter C, et al. Efficacy of methocarbamol for acute pain management in young adults with traumatic rib fractures. Ann Pharmacother. 2021;55:705–710.
Komatsu R, Nash M, Peperzak KA, et al. Comparison between preoperative methadone and buprenorphine use on postoperative opioid requirement: a retrospective cohort study. Clin J Pain. 2022;38:311–319.
Aljuhani O, Kopp BJ, Patanwala AE. Effect of methocarbamol on acute pain after traumatic injury. Am J Ther. 2017;24:e202–e206. Published online.
Patanwala AE, Aljuhani O, Kopp BJ, et al. Methocarbamol use is associated with decreased hospital length of stay in trauma patients with closed rib fractures. Am J Surg. 2017;214:738–742.
Poljak D, Chappelle J. The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery. J Perinat Med. 2020;48:153–156.