Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway

Abstract

BACKGROUND: Opioids are overprescribed after surgical procedures, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgical procedures. STUDY DESIGN: Patients undergoing 6 procedures were offered the opportunity to participate in an opioidsparing pain management pathway. Patients were advised to use acetaminophen and ibuprofen, and were provided with a small "rescue" opioid prescription for breakthrough pain. They were then surveyed postoperatively about opioid use and patient-reported outcomes measures. Overall cohort characteristics and differences between opioid users and non-users were analyzed. RESULTS:A total of 190 patients were analyzed. Median prescription size was 5 (interquartile range [IQR] 4 to 6) pills and opioid use was 0 (IQR 0 to 4) pills. Fifty-two percent of patients used no opioids after procedures. Median number of leftover pills was 2 (IQR 0 to 5). Median pain score was 1 (IQR 1 to 2) and satisfaction score was 10 (IQR 8 to 10). Almost all (91%) patients agreed that their pain was manageable. Patients who used opioids were younger (52 AE 14 vs 59 AE 13 years; p ¼ 0.001), reported higher pain scores (2 [IQR 1 to 2] vs 1 [1 to 2]; p ¼ 0.014), received larger rescue prescriptions (6 AE 3 vs 4 AE 4 pills; p ¼ 0.003), and were less likely to agree that their pain was manageable (82% vs 98%; p ¼ 0.001). There were no other significant differences between opioid users and non-users. CONCLUSIONS: Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures. (J Am Coll Surg 2019;229:316e322. Ó

Preoperative patient education and patient preparedness are associated with less postoperative use of opioids

“…3,6 Several initiatives have now shown that surgical providers can prescribe fewer opioids at discharge without consequences of increased patient suffering or requests for refills. [7][8][9] These cliniciantargeted strategies, such as decreasing the default prescription quantities in the electronic health record and grand rounds presentations, have resulted in decreases in the prescribing of opioids postoperatively. 9,10 Although decreasing the prescribing of opioids is important, decreasing the amount of opioids actually used by patients and disposing of any excess pills after an operation would have further beneficial effects on decreasing unintended chronic opioid use.…”

Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

“… 47 Oral administration has been reproducibly demonstrated to be effective for preoperative and postoperative analgesia, specifically. 36 , 48 , 49 Oral dosage protocols range from 650 to 1000 mg and favor “around-the-clock” administration, typically every 6 hours. There have been no high-level studies comparing the effectiveness of dosage differences for the indication of perioperative pain management.…”

“… 65 Unfortunately, a recent review of prescribing practices in plastic surgery notes that only 45% and 37% of surgeons report routinely counseling their patients on the risks of addiction and secure medication storage, respectively. 48 …”

A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic

“…Opioid use decreased by 72% with an opioid-sparing pathway and opioid-naïve patients experienced positive outcomes with high satisfaction (Hallway et al, Meyer et al, 2018;Zhou et al, 2017). Specifically, evidence showed an opioid-sparing pathway reduced median postoperative opioid use to ten pills or less (average of four pills) in 98% of patients (Hallway et al, 2019).…”

“…Opioid-sparing techniques may also result in no postoperative opioid use when patients utilize a combination of acetaminophen and ibuprofen (Hallway et al, 2019). One narrative review found multimodal techniques significantly improved postoperative pain scores but specifically showed opioid-free analgesia had the highest patient and surgeon satisfaction (Nassif & Miller, 2018).…”