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Posted: April 13th, 2023
Reducing Opioid Prescribing After Surgery
Opioids are powerful painkillers that are often prescribed to patients after surgery. However, opioids also have serious risks, such as addiction, overdose, and side effects. Therefore, reducing opioid prescribing and consumption after surgery is an important goal for surgeons and patients alike.
According to a study by Ayoub et al. (2021), many patients receive their first opioid prescription from a surgeon, and one of every 17 patients who uses an opioid after otolaryngologic surgery continues to require opioids long after postoperative care has been completed. Moreover, evidence is accumulating that nonopioid medications are highly effective for postoperative pain and may offer substantial advantages compared with opioids in improved safety.
Some strategies to reduce opioid use after surgery include:
– Using a patient-centered prescribing guideline that takes into account each patient’s perception of pain, rather than prescribing opioids based on type of operation. A guideline developed by surgeons at the Dartmouth-Hitchcock Medical Center recommends discharging patients with no prescription for opioids if they have taken no opioids on the day before; 15 pills if they have taken one to three pills; and 30 pills if they have had four or more pills. This guideline was shown to satisfy the pain management needs of 93% of patients and to increase the proper disposal of unused pills.
– Using a multimodal regimen that includes medications such as acetaminophen, ibuprofen, and sometimes even ketamine or antidepressants. These adjuvant medications should be initiated prior to surgery, with some continuing through the perioperative period. They can reduce the reliance on opioids and provide better pain relief.
– Educating patients about the risks and benefits of opioids, setting realistic expectations for pain management, and providing specific instructions for pill disposal. Surgeons play a pivotal role in minimizing opioid use in their patients by informing them about the alternatives to opioids, the potential harms of opioids, and the proper ways to dispose of unused pills . A convenient option for pill disposal is a pharmacy drop box.
– Tapering or stopping opioids as soon as possible after surgery. For acute pain after surgery, opioids should be prescribed as part of a multimodal regimen, at the lowest effective dose, as immediate-release, and usually for three to seven days only. Patients who take opioids as needed less than once per day do not need a formal taper and can be immediately ceased. The longer the patient has been taking opioids, the longer the reduction process must be.
By following these strategies, surgeons and patients can reduce opioid prescribing and consumption after surgery, and thus prevent the potential harms of opioid misuse and addiction. According to a report by HealthDay News (2022), the overall amount of opioids prescribed to Americans after their surgeries fell by 66% between 2016 and 2022. This trend is encouraging and shows that reducing opioid use after surgery is possible and beneficial.
References:
: Ayoub NF, Choby G, Turner JH, et al. Assessment of Opioid Use and Analgesic Requirements After Endoscopic Sinus Surgery. JAMA Otolaryngol Head Neck Surg. 2021;147(9):825–831. doi:10.1001/jamaoto.2021.1845
: Brenner MJ. Reducing Opioid Prescribing and Consumption After Surgery—Keeping the Lock on Pandora’s Box. JAMA Otolaryngol Head Neck Surg. 2021;147(9):819–821. doi:10.1001/jamaoto.2021.1846
: Barth RJ Jr., Chagpar AB, Tosteson ANA, et al. Guideline for Reducing Opioid Use Post-Surgery Leads to High Pain Management Satisfaction and Disposal Rates: A Prospective Study of a Patient-Centered Prescribing Guideline for General Surgery Patients Undergoing Major Operations. J Am Coll Surg. 2021;233(4):409-417.e2. doi:10.1016/j.jamcollsurg.2021.05.009
: Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Reducing opioid use in patients before and after surgery. Medicine Today 2020; 21(7): 28-35.
: Reinberg S. You’re Far Less Likely to Get an Opioid Now After Surgery [Internet]. HealthDay News; 2022 Jan 12 [cited 2022 Jan 13]. Available from: https://www.healthday.com/health-news/pain-management/youre-far-less-likely-to-get-an-opioid-now-after-surgery
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