BACKGROUND AND PURPOSE:

• Mark et al. (JAMA Open, 2018) assessed whether postsurgical acute pain can be managed post-discharge with a very restrictive opioid policy in place

METHODS:

• Prospective Case | Retrospective control cohort study
  • Controls: Prior to 2017, Gyn Onc prescribed opioids “liberally”
  • Cases: From June 26, 2017, through June 30, 2018, an ultrarestrictive opioid prescription protocol (UROPP) was implemented
• UROPP protocol
  • Ambulatory or minimally invasive surgery (laparoscopic or robotic approach): Not routinely prescribed opioids at discharge
    • Opioids were prescribed if more than 5 doses of oral or intravenous opioids were required while in the hospital
  • Laparotomy: Provided a 3-day opioid pain medication supply at discharge
• Total number of opioid pain medications prescribed in the 60-day perioperative period, requests for opioid prescription refills, and postoperative pain scores and complications were evaluated
• Primary Outcomes
  • Mean postoperative pain score 2 weeks after surgery
  • New requests for opioid refills within 30 days after surgery
• Secondary Outcomes
  • Complications within 30 days after the procedure, based upon the American College of Surgeons National Surgical Quality Improvement Program

RESULTS:

• Patient demographics and procedure characteristics were not statistically different between the 2 cohorts of women
  • 605 cases | 626 controls
• Mean (SD) number of opioid tablets given at discharge after laparotomy (P < .001)
  • Controls: 43.6 (17.0)
  • Cases: 12.1 (8.9)
• Mean (SD) number of opioid tablets given at discharge after laparoscopic or robotic surgery (P < .001)
  • Controls: 38.4 (17.4)
  • Cases: 1.3 (3.7)
• Mean (SD) number of opioid tablets given at discharge after ambulatory surgery (P < .001)
  • Controls: 13.9 (16.6)
  • Cases: 0.2 (2.1)
• There was no significant increase in
  • Number of refill requests: 16.6% in controls vs 16.5% in cases (P=.99)
  • The mean postoperative visit pain scores: 1.4 in controls vs 1.1 in cases (P = .06)
  • Number of complications: 6.7% in controls vs 4.8% in cases (P = .15)

CONCLUSION:

• An ultrarestrictive opioid policy used by a gyn oncology service was not associated with increased refills, postoperative pain or complications
• The authors note that the protocol is sustainable and 98% of the health care professionals are in compliance

Learn More – Primary Sources:

Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery

Related ObG Topics:

Are the Number of Opioid Pills Prescribed Related to Consumption in Post-Op Patients?

Do Non-Opioids Work as Well as Opioids for Acute Extremity Pain? 

Should Opioid Medications Be Left Out of the Treatment Plan?