Abstract
Abstract
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.