Avoiding Narcotics

With the improvements in rapid recovery surgery using multimodal therapy, we’ve audited our tramadol usage, which has been accepted for publication in ANZ Journal of Surgery.

364 patients undergoing arthroplasty surgery 2018-19 were audited.  4.9% were not prescribed tramadol and a further 4.3% reported an adverse effect.  16% of the whole group were already on an antidepressant, but only two of these reported an adverse effect (one sweating, one constipation). LIA injections, meloxicam, paracetamol, and buprenophone patches usually provide the background analgesia.

We have subsequently taken to prescribing our tramadol as 50mg three hourly as necessary to minimise the incidence of side effects.  In patients already on a maximal dose of antidepressants SSRI or SNRI, or any dose of MOAI, it is necessary to individualise a solution.  Tapentadol may be a useful alternate.  We avoid oxycodone where-ever possible, but in the rare instances of prescribing it, suggest a slow-release narcotic at night-time to avoid waking in pain becoming a chronic pain behaviour.