411: Factors Influencing Prescribing of Modified-Release Opioids For Postoperative Pain: A Scoping Review

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

Background and Aims: Emerging evidence discourages the use of modified-release (MR) opioids for acute postoperative pain[1]. Despite this, MR opioids continue to be prescribed postoperatively[2-3]. This scoping review aimed to identify factors influencing clinicians’ decisions to prescribe oral MR opioids for postoperative pain.

Methods: A systematic search was conducted across three electronic databases. Studies were included if they were original, peer-reviewed research that explored clinicians’ decision-making regarding the prescribing of oral MR opioids for postoperative pain. Due to an absence of evidence, a secondary search identified original data and author-reported rationales that may impact clinicians’ decision to prescribe oral MR opioids for postoperative pain from randomised controlled trials and observational studies.

Results: Of 9111 screened articles, 0 articles met the criteria for the primary search. For the secondary search, 24 articles were identified and included in the analysis. Original data identified potential factors that were categorised as either patient, surgical or health system & governance factors. Among the included studies, author-reported rationales from non-industry-funded studies predominantly argued against the use of MR opioids for postoperative pain. Conversely, most studies that promoted MR opioid use were from industry-funded studies.

Conclusions: This scoping review found no empirical evidence on clinician factors influencing the prescribing of MR opioids for postoperative pain management. The secondary search and author-reported rationales identified patient factors, surgical factors, health system & governance factors, and perceived clinician attitudes & knowledge may affect MR opioid prescribing for postoperative pain.

References: 1. Liu S, Athar A, Quach D, et al. Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis. Anaesthesia 2023; 78: 1225-36.
2. Srivastava D, Hill S, Carty S, et al. Surgery and opioids: evidence-based expert consensus guidelines on the perioperative use of opioids in the United Kingdom. Br J Anaesth 2021; 126: 1208-16.
3. Awadalla R, Liu S, Kemp-Casey A, et al. Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study. Anaesthesia 2021; 76(12): 1607-15.

Presenting Author: Katelyn Jauregui
Submitting Author: Katelyn Jauregui

Senior Author: Shania Liu and Jonathan Penm

IASP 2026 Global Year theme of Neuropathic Pain: No

• Celine Moussa - The University of Sydney
• Katelyn Jauregui - The University of Sydney
• Kingston Yeung - The University of Sydney
• Asad E Patanwala - The University of Sydney
• Axel R Sauter - Oslo University Hospital
• Akm Akhtaruzzaman - Bangladesh Medical University
• Regina LM Van Boekel - HAN University of Applied Sciences
• Jennifer Stevens - St Vincent's Hospital, Sydney
• Roger Knaggs - University of Nottingham
• Daniel Arendt - University of Cincinnati
• Gilliam M Chumbley - Imperial College Healthcare NHS Trust
• Felicia Cox - Royal Brompton and Harefield NHS Foundation Trust
• Esther M Pogatzki-Zahn - University Hospital Muenster
• Ruth Zaslansky - Jena University Hospital
• Jane Quinlan - Oxford University Hospitals NHS Foundation Trust
• Shania Liu - The University of Sydney
• Jonathan Penm - The University of Sydney