S110—Opioid-free analgesia after outpatient general surgery: A qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial

Do, Uyen; Pook, Makena; Najafi, Tahereh; Rajabiyazdi, Fateme; El-Kefraoui, Charbel; Balvardi, Saba; Barone, Natasha; Elhaj, Hiba; Nguyen-Powanda, Philip; Lee, Lawrence; Baldini, Gabriele; Feldman, Liane S.; Fiore, Julio F.

doi:10.1007/s00464-022-09472-8

Cited by 4 publications

(5 citation statements)

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“…The widespread prescription of opioids for pain increased rapidly in the 1990s, resulting in the 'first wave' of opioid overdoses in the United States [3]. Recently, evidence has shown that many General Surgery patients are prescribed opioids upon discharge, with uncertain benefits for pain control [4]. In fact, providers may overprescribe opioids postoperatively, giving patients more pills than necessary [5,6].…”

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confidence: 99%

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

Alzatari,

Huang,

Poulose

2024

Hernia

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Purpose Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management. Methods The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019–2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups. Results 1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients’ pain levels were similar between opioids vs non-opioids (median (IQR): 31(31–40) vs. 31(31–40), p = 0.46), and HerQLes summary scores were similar (92(78–100) vs. 90(59–95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0–5) vs 2(0–6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1). Conclusion Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.

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Section: Introductionmentioning

confidence: 99%

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

Alzatari,

Huang,

Poulose

2024

Hernia

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“…Of course, the novelty of the study by Do et al 1 is not in the desire to identify an optimal strategy for managing postoperative pain but in specifically establishing the feasibility of studying the impact of opioid-free pain management. This extends at least in part from literature that showed that rates of new persistent opioid use, defined as previously opioid-naive patients filling opioid prescriptions more than 90 days after their index procedure, were 5.9% and 6.5% after minor and major surgery, respectively.…”

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confidence: 99%

“…5 One of the most common barriers to participation in the study by Do et al 1 was preconceptions of the patients about the efficacy of opioidfree analgesia. 1 This is likely true among physicians and health care teams as well. As a result, it is necessary to prove not only that a trial of this sort can be conducted in the present health care practice environment but also that the trial methods maintain the necessary rigor to truly assess for therapeutic equipoise.…”

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confidence: 99%

“…As a result, it is necessary to prove not only that a trial of this sort can be conducted in the present health care practice environment but also that the trial methods maintain the necessary rigor to truly assess for therapeutic equipoise. There is reason to be optimistic about the latter because Do et al 1 traditional pain-related end points, comprehensive patient-reported assessment tools, and relevant clinical outcomes, and their preliminary data suggest that opioid-free analgesia may translate to a broader patient sample.…”

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confidence: 99%

“…1 suggests, to begin such an investigation, practice makes perfect.July 18, 2022. doi:10.1001/jamanetworkopen.2022.21441 Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Grant MC.…”

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Investigating Opioid-Free Analgesia—Practice Makes Perfect

Grant

2022

JAMA Netw Open

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As the medical community continues to highlight the many causes and consequences of the present opioid crisis in North America, opioid-free perioperative analgesia has emerged as one potential strategy to mitigate a key factor associated with chronic opioid use. It was with interest, then, that I reviewed the article by Do and colleagues, 1 written on behalf of the McGill Better Opioid Prescribing Collaboration. The authors detailed the results of an assessor-blinded, pragmatic pilot randomized clinical trial investigating the feasibility of conducting a full comparative effectiveness trial of prescribing postoperative opioid analgesia compared with opioid-free analgesia among patients undergoing outpatient general surgery. In both trial arms (opioid: 39 participants; opioid-free: 37 participants), patients received protocolized around-the-clock nonopioids as first-line therapy, with patients in the opioid analgesia group receiving opioids in the event of breakthrough pain. The trial achieved its primary objective, a strict set of a priori feasibility outcomes that, aside from the traditional eligibility and follow-up criteria, established thresholds for agreement to participate on the part of patients and surgeons and for treatment adherence. Although not the basis for the trial, the researchers also reported a number of secondary clinical outcomes, including similar findings between groups for self-reported pain and satisfaction scores and preliminary data for opioid-related adverse events. The trial's feasibility, coupled with the extensive number of assessments, may serve as a framework for future, large-scale investigation.

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Experiences and perspectives of adults on using opioids for pain management in the postoperative period

Aljohani,

Almalki,

Adam

et al. 2023

European Journal of Anaesthesiology Intensive Care

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OBJECTIVE To identify and examine the available studies regarding adult perceptions and experiences of postoperative opioid pain management. INTRODUCTION The opioid crisis has been acknowledged as a significant clinical and social problem in many countries. Opioids are often initiated after surgery and may be continued on hospital discharge. There is no consensus on the optimal strategy for integrating patients’ views in postoperative opioid prescribing. The aim of this review is to explore the literature on adults’ experiences with postoperative opioid pain management. INCLUSION CRITERIA This review will consider all qualitative studies and mixed-method studies with qualitative approaches that explored adults’ opinions or concerns on opioids and/or opioid reduction, and adults’ satisfaction with pain control in this context. Participants in the studies should be adults who had undertaken any type of surgery and have had opioid prescriptions for pain management. METHODS This scoping review will be carried out in accordance with the Joanna Briggs Institute (JBI) methodology and will utilise the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews (PRISMA-ScR) reporting guideline and checklist. Searches will be conducted in Ovid MEDLINE, PsycInfo, EMBASE and CINAHL (EBSCO). Studies published in the English language will be included with no time limit. The screening and selection of studies will be carried out independently by three reviewers. Then data extraction process will be conducted by the main reviewer and the reviewer's supervisors independently. A descriptive qualitative content analysis will be utilised for data synthesis. The final report will contain a methodological quality assessment, with the findings being presented, including the knowledge gaps and recommendations for research.

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S110—Opioid-free analgesia after outpatient general surgery: A qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial

Cited by 4 publications

References 51 publications

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair

Investigating Opioid-Free Analgesia—Practice Makes Perfect

Experiences and perspectives of adults on using opioids for pain management in the postoperative period

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