A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty

Tamboli, Mallika; Mariano, Edward R.; Gustafson, Kerianne E; Briones, Beverly L; Hunter, Oluwatobi O; Wang, Rachel R.; Harrison, T. Kyle; Kou, Alex; Mudumbai, Seshadri C.; Kim, T Edward; Indelli, Pier Francesco; Giori, Nicholas J.

doi:10.1093/pm/pnz260

Cited by 27 publications

(27 citation statements)

References 26 publications

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“…Interestingly, Howard et al (2018) found that after implementing evidence-based opioid prescribing recommendations for a single surgical procedure (laparoscopic cholecystectomy), discharge opioid prescriptions decreased for four other unrelated surgical procedures without significantly affecting refill rates, described as the “spillover effect” [ 37 ]. In addition to procedure-specific protocols, recent studies suggest that patient-specific prescribing and tapering protocols based on a review of the patient’s personal opioid consumption prior to discharge leads to decreased persistent opioid use after discharge [ 38 , 39 ]. Other simple yet effective interventions include lowering discharge opioid prescription defaults in the electronic health system [ 40 ] and the creation of evidence-based procedure-specific discharge ordering sets [ 41 ].…”

Section: Postoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

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Purpose of Review This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients. Recent Findings The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. Summary While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.

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Section: Postoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

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“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

Section: Resultsmentioning

confidence: 99%

“…Risk factors for chronic opioid use (e.g., previous opioid use, benzodiazepine use, substance abuse, mental health disorder, chronic pain) were measured in close to 70% of studies [ 5 , 50 , 51 , 56 – 58 , 61 , 63 , 64 , 67 , 68 , 72 – 74 , 78 , 79 , 82 – 89 , 92 – 95 , 97 – 100 , 102 – 114 ] (Supplemental Digital File 4 : Risk factors for chronic opioid use in included studies by types of strategies). The main risk factors involved were depression/anxiety or associated medication use [ 51 , 53 , 56 , 57 , 63 , 64 , 72 – 74 , 78 , 79 , 82 , 83 , 85 – 89 , 92 , 97 , 100 , 102 , 104 , 107 , 109 , 112 , 114 ], and prior opioid use [ 5 , 53 , 57 , 58 , 61 , 63 , 64 , 67 , 68 , 73 , 74 , 78 , 82 , 83 , 85 – 89 , 95 , 97 –…”

Section: Resultsmentioning

confidence: 99%

“…The main risk factors involved were depression/anxiety or associated medication use [ 51 , 53 , 56 , 57 , 63 , 64 , 72 – 74 , 78 , 79 , 82 , 83 , 85 – 89 , 92 , 97 , 100 , 102 , 104 , 107 , 109 , 112 , 114 ], and prior opioid use [ 5 , 53 , 57 , 58 , 61 , 63 , 64 , 67 , 68 , 73 , 74 , 78 , 82 , 83 , 85 – 89 , 95 , 97 – 100 , 102 – 104 , 107 – 109 , 111 , 113 , 114 ]. Amongst studies that included patients at risk for chronic opioid use, nearly 60% [ 51 , 53 , 63 , 64 , 72 , 74 , 78 , 82 , 83 , 85 , 89 , 94 , 95 , 97 – 100 , 102 – 104 , 106 , 10...…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Background Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. Methods This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. Results A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. Conclusions This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

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“…A recent article describing a multidisciplinary patient-specific opioid prescribing and tapering protocol after lower extremity arthroplasty suggests a reasonable goal of return to baseline opioid use after recovery from surgery. 28 In conclusion, there has been tremendous progress in the field of acute perioperative pain medicine. Effective pain management to facilitate early mobility is a critical element of modern ERPs for surgical patients.…”

Section: After Surgerymentioning

confidence: 99%