Clinical Protocol May Limit Opioid Prescribing After General Surgery

Excess and unused prescriptions play a significant role in the rise of opioid abuse. Recent research evaluating the impact of implementing a new standardized pain care bundle to reduce postoperative opioid prescriptions after outpatient general surgical procedures found that the bundle decreased opioid prescribing and often eliminated opioid use, while also treating postoperative pain and improving patient satisfaction.

The study investigated 224 patients who underwent laparoscopic cholecystectomy or open hernia repair (inguinal, umbilical) before the intervention and compared them to with 192 patients post intervention. The researchers applied a multimodal intra- and postoperative analgesic bundle, including promoting coanalgesia, opioid-reduced prescriptions, and patient education that was designed to clarify patient expectations, according to the authors.

“By significantly reducing the amount of opioids prescribed, this decreases the exposure risk and potential for misuse of narcotic medication,” lead study author Luke B. Hartford, DVM, MD, a resident in general surgery at Western University's Schulich School of Medicine & Dentistry, said in a statement. “This also decreases excess medication available to be diverted to individuals for whom it was not intended.”

In addition, patients completed a pain inventory at their first postoperative visit, which was used to establish the primary end point of patient-reported average pain in the first postoperative days.

The results demonstrated that there was no difference in average postoperative pain scores in the pre- versus postintervention groups, whereas the reported quality of pain control improved post intervention. Furthermore, the median total morphine equivalents for prescriptions filled in the postintervention group were significantly less. Also, according to the results, only 78 of 172 patients filled their opioid prescription in the postintervention group, without a significant difference in prescription renewals.

“If we can decrease the opioid exposure risk in our patients, and decrease the amount of excess medication available for diversion, and spread this to other institutions and surgical procedures and specialities, this has the potential to significantly impact the opioid crisis,” said coauthor Patrick B. Murphy, MD, MSc, MPH, a resident in general surgery at the Schulich School of Medicine & Dentistry.

The researchers hope that this protocol that instructs physicians to limit the number of opioid pills they prescribe to patients can be expanded for applications other than just general surgery in the future.

Reference

Hartford LB, Van Koughnett JAM, Murphy PB, et al. Standardization of outpatient procedure (STOP) narcotics: a prospective non-inferiority study to reduce opioid use in outpatient general surgical procedures [published online October 22, 2018]. J Am Coll Surg. doi: 10.1016/j.jamcollsurg.2018.09.008.