Precise Analgesic Instructions Improve Narcotic Usage: A Randomized Trial

Abstract

Background Given the ongoing battle with opioid abuse and over-use in the United States new strategies are consistently being implemented in an attempt to reduce opioid use and over prescribing. Objectives The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken. Methods Blinded randomized prospective study comparing a total of 110 (Group A=55, Group B=55) women undergoing elective outpatient bilateral breast reduction surgery by two different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain. Results Patients in group B took on average 1.5 oxycodone while patients in group A took on average 5.7 oxycodone (p<0.01). Thirty-four patients in group B took no oxycodone. Patients in group B also had statistically significant lower subjective pain scores. Conclusions Based on these results it appears that standardizing how patients are instructed to treat their pain post-operatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

Evaluating the effect of preoperative interventions on sleep health in the perioperative period: a systematic review

“…Trials were further subdivided by delivery timepoint such that trials delivered exclusively in the preoperative period were separated from those delivered both preoperatively and postoperatively (i.e., perioperative interventions). In all, 28 were randomised trials (Babaee et al, 2007; de Moor et al, 2008; Dianatkhah et al, 2015; Erz et al, 2022; Farr et al, 2001; Garssen et al, 2013; Gross et al, 2017; Hansen et al, 2014; Heidarnia et al, 2005; Kekecs et al, 2014; Kilpio et al, 2021; Knoerl et al, 2022;Kurdi et al, 2021; Liu et al, 2020; Madsen et al, 2016; Mousavi Malek et al, 2018; Muneyyirci‐Delale et al, 2007; Myles et al, 2004; Ou et al, 2021; Roehrs & Roth, 2017; Savci et al, 2011; Shakya et al, 2019; Stoerkel et al, 2018; Villacampa et al, 2022; Wong et al, 2012; Yang et al, 2021; Yang et al, 2022; Zhao et al, 2022;) and 19 were non‐randomised trials (Adriaans et al, 2022; Alejo et al, 2019; Bagaphou et al, 2019; Barral et al, 2020; Brunet et al, 2017; Diaz & Larsen, 2005; Febrero et al, 2018; Gong et al, 2018; Hassamal et al, 2016; Li et al, 2022; Loughney et al, 2017; Morielli et al, 2016; Ren et al, 2020; Rouhani et al, 2014; Singh et al, 2017; Singh et al, 2018; Wong et al, 2014; Zheng et al, 2022). Overall, 4937 participants were included in these 47 trials.…”

“…The risk of bias of the RCTs is presented in Figure S2 (Sterne et al, 2019). The risk of bias judgements were as follows: 11 were high risk of bias (Babaee et al, 2007; de Moor et al, 2008; Dianatkhah et al, 2015; Erz et al, 2022; Heidarnia et al, 2005; Madsen et al, 2016; Mousavi Malek et al, 2018; Ou et al, 2021; Roehrs & Roth, 2017; Shakya et al, 2019; Zhao et al, 2022), 13 had some concerns (Farr et al, 2001; Garssen et al, 2013; Gross et al, 2017; Kekecs et al, 2014; Kilpio et al, 2021; Knoerl et al, 2022; Liu et al, 2020; Muneyyirci‐Delale et al, 2007; Myles et al, 2004; Stoerkel et al, 2018; Villacampa et al, 2022; Yang et al, 2021), and four were low risk of bias (Hansen et al, 2014; Kurdi et al, 2021; Wong et al, 2012; Yang et al, 2022). In randomised trials, failure to pre‐register and potential of selective reporting was a common source of bias (i.e., selection of the reported result).…”

“…For example, 29 trials used non‐pharmacological interventions including exercise, nutrition, psychological intervention, sleep, and one intervention that was specific to the surgical procedure (Adriaans et al, 2022; Alejo et al, 2019; Babaee et al, 2007; Barral et al, 2020; Brunet et al, 2017; Canfield et al, 2021; de Moor et al, 2008; Diaz & Larsen, 2005; Farr et al, 2001; Febrero et al, 2018; Garssen et al, 2013; Gong et al, 2018; Gross et al, 2017; Hassamal et al, 2016; Heidarnia et al, 2005; Kekecs et al, 2014; Knoerl et al, 2022; Kurdi et al, 2021; Li et al, 2022; Loughney et al, 2017; Morielli et al, 2016; Mousavi Malek et al, 2018; Roehrs & Roth, 2017; Savci et al, 2011; Singh et al, 2017; Singh et al, 2018; Stoerkel et al, 2018; Wong et al, 2014; Yang et al, 2021; Yang et al, 2022). Enhanced recovery after surgery (ERAS) or enhanced nursing protocols were used in eight trials, characterised by inpatient interventions primarily delivered by nurses (Erz et al, 2022; Gong et al, 2018; Kilpio et al, 2021; Liu et al, 2020; Ou et al, 2021; Ren et al, 2020; Zhao et al, 2022; Zheng et al, 2022). Finally, 10 trials used pharmacological interventions, including two smoking cessation interventions.…”

“…In all, 17 randomised (Babaee et al, 2007; de Moor et al, 2008; Dianatkhah et al, 2015; Erz et al, 2022; Garssen et al, 2013; Gross et al, 2017; Hansen et al, 2014; Heidarnia et al, 2005; Kekecs et al, 2014; Kilpio et al, 2021; Madsen et al, 2016; Mousavi Malek et al, 2018; Ou et al, 2021; Savci et al, 2011; Shakya et al, 2019; Stoerkel et al, 2018; Wong et al, 2012) and 10 non‐randomised (Bagaphou et al, 2019; Diaz & Larsen, 2005; Febrero et al, 2018; Gong et al, 2018; Hassamal et al, 2016; Morielli et al, 2016; Ren et al, 2020; Rouhani et al, 2014; Zheng et al, 2022) trials measured sleep quality (or disturbance) among 2372 participants. Overall, 13 trials reported improved sleep quality, eight trials did not improve sleep quality, and four trials did not compare to a usual care or control group.…”

“…Overall, 13 trials reported improved sleep quality, eight trials did not improve sleep quality, and four trials did not compare to a usual care or control group. Sleep quality was improved relative to comparator by two trials in the preoperative period (Mousavi Malek et al, 2018; Zheng et al, 2022), four trials in the immediate postoperative period (within 48 h of surgery) (Dianatkhah et al, 2015; Ou et al, 2021; Rouhani et al, 2014; Zheng et al, 2022), four trials in the intermediate postoperative period (>48 h to ≤2 weeks postoperatively) (Bagaphou et al, 2019; Erz et al, 2022; Savci et al, 2011; Zheng et al, 2022), and four trials in the long‐term postoperative period (>2 weeks postoperatively) (Babaee et al, 2007; Heidarnia et al, 2005; Kilpio et al, 2021; Shakya et al, 2019). The most common measures of sleep quality were the Pittsburgh Sleep Quality Index (PSQI) (six trials: de Moor et al, 2008; Gross et al, 2017; Morielli et al, 2016; Ou et al, 2021; Shakya et al, 2019; Zheng et al, 2022) and Nottingham Health Profile (NHP) (four trials: Babaee et al, 2007; Febrero et al, 2018; Heidarnia et al, 2005; Savci et al, 2011).…”