• Chia-Hung Yu, Yi-Chen Chen, I-Yin Hung, Jen-Yin Chen, Ying-Jen Chang, Chung-Han Ho, and Chin-Chen Chu.
• Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan.
• J Clin Anesth. 2021 Dec 1; 75: 110438.

Study ObjectiveChronic postsurgical pain (CPSP) is a common and underreported but significant outcome following surgery. Pharmacological treatment with analgesics, including non-opioids and opioids, is frequently used. It has been debated whether neuraxial anesthesia can reduce persistent analgesic use. We aimed to survey long-term analgesic prescription after different surgeries under general and neuraxial anesthesia, using a nationwide database.DesignRetrospective case-control study.SettingThis study used data corresponding to the period from 2000 to 2016 from a longitudinal generation tracking database, which includes the claims data of 2 million randomly selected beneficiaries in Taiwan.PatientsPatients (n = 110,654) who underwent herniorrhaphy, hip/knee replacement, and lower-limb open reduction internal fixation (ORIF) or amputation were enrolled.InterventionsWe categorized patients into general or neuraxial anesthesia groups, compared the rates of long-term analgesic prescription between the two groups, and estimated the adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) using multivariable logistic regression analysis.Main ResultsLower rates of long-term analgesic prescription were noted in patients who underwent herniorrhaphy (3 months post-surgery: aOR, 0.88; 95% CI, 0.84-0.93; 6 months post-surgery: aOR, 0.90; 95% CI, 0.84-0.96), hip replacement (3 months post-surgery: aOR, 0.91; 95% CI, 0.85-0.97), and lower-limb ORIF (3 months post-surgery: aOR, 0.91; 95% CI, 0.88-0.94; 6 months post-surgery: aOR, 0.95; 95% CI, 0.92-0.99) under neuraxial anesthesia than under general anesthesia. Lesser long-term opioid prescription after herniorrhaphy (3 months post-surgery: aOR, 0.52; 95% CI, 0.36-0.75; 6 months post-surgery: aOR, 0.58; 95% CI, 0.42-0.81) and lower-limb ORIF (3 months post-surgery: aOR, 0.55; 95% CI, 0.47-0.65; 6 months post-surgery: aOR, 0.67; 95% CI, 0.56-0.80) was observed under neuraxial anesthesia than under general anesthesia.ConclusionsNeuraxial anesthesia may be associated with lower rates of long-term analgesic and opioid prescription after some surgeries, especially herniorrhaphy and lower-limb ORIF.Copyright © 2021 Elsevier Inc. All rights reserved.

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