423: Prescribing Practices of Non-Morphine Opioids among Danish Orthopaedic Inpatients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Pharmacological treatments

Background and Aims: Opioids remain essential for acute pain management in orthopaedic surgery. Danish national guidelines recommend morphine as first-line treatment, but still a significant number of inpatients at the Depart-ment of Orthopaedic Surgery at Hvidovre Hospital, continue to be prescribed non-morphine opioids. This is concerning given the risk of misuse and addiction potential associated with opioid such as tramadol and oxycodone. This study describes the clinical decisions leading to prescription of opioids other than morphine for acute pain management.

Methods: This cross-sectional descriptive study was conducted from 13 January to 30 April 2025 at the Department of Orthopaedic Surgery at Hvidovre Hospital, Denmark. Eligible participants were inpatients aged ≥ 18 years admitted with hip fractures, wounds, or amputations, who received at least one prescription for a non-morphine opioid during hospitalisation. Patients who declined use of their medical data for research purposes were excluded. All data were extracted from the electronic medical records systems, Sundhedsplatformen (EPIC™).

Results: Of 308 eligible inpatients; 89 were included, accounting for 100 prescriptions of non-morphine opioids. The patients were predominantly older (≥ 65 years, 88%), with polypharmacy (82%), and multimorbidity (≥ 3 comorbidities, 41%). Median eGFR was 56 mL/min/1.73 m2 [IQR:36, 80]. Oxycodone was most frequently prescribed (68%), followed by fentanyl (19%) and tramadol (5%). The main reasons for prescription were non-morphine opioid prescription pre-admission (43%), impaired renal function (17%), and documented morphine intolerance (13%). Among 13 patients prescribed oxycodone due to impaired renal function, only two met the recommended criteria of eGFR < 30 ml/min/1.73 m2.

Conclusions: Non‑morphine opioids were prescribed to 29% of orthopaedic inpatients admitted with hip fractures, wounds, or amputations. Clinical prescribing practices were generally in agreement with national guide-lines. Increased focus on correct evaluation of renal function and morphine dose adjustments may further advance rational opioid prescribing in acute post-surgical pain management.

References: None

Presenting Author: Rie Bager Hansen
Submitting Author: Rie Bager Hansen

Senior Author: Rie Bager Hansen

IASP 2026 Global Year theme of Neuropathic Pain: No

• Manal Hdidouch: M.Sc. - Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark The Capital Region Pharmacy, Herlev, Denmark
• Intisar Liban Osman: M.Sc. - Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; The Capital Region Pharmacy, Herlev, Denmark
• Morten Baltzer Houlind: PhD - Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark;The Capital Region Pharmacy, Herlev, Denmark; Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark