Tackling the opioid epidemic: Reducing opioid prescribing while maintaining patient satisfaction with pain management after outpatient surgery

Allan, Lauren; Coyne, Catherine; Byrnes, Cheryl M.; Galet, Colette; Skeete, Dionne

doi:10.1016/j.amjsurg.2020.04.006

Cited by 12 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When decreasing opioid use through restrictive opioid prescribing protocols, it is imperative to ensure that patients' postoperative pain is satisfactorily managed. 14,23,24 However, there will continue to be leftover opioids because every patient requires different amounts, and it is important that surgeons educate their patients on safe disposal methods. Education alone has shown an increase of opioid disposal from around 10–40%.…”

Section: Discussionmentioning

confidence: 99%

Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery

Boitano

Norton

Shrestha

et al. 2021

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE: To evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery. METHODS: This prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26. RESULTS: Two hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91–97) filled their opioid prescription and 64 (41%, 95% CI 34–48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67–79) discarded them; 78%, 95% CI 69–80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again. CONCLUSION: Despite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.

show abstract

Section: Discussionmentioning

confidence: 99%

Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery

Boitano

Norton

Shrestha

et al. 2021

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…[1][2][3] After surgery there is also an increased risk of developing opioid dependency which is why opioid usage in the perioperative setting should be limited. 4 There is no consensus on which analgesic regimes should be incorporated into the multimodal analgesia components of ERAS programs for colorectal surgery and this is especially an issue with increasing use of laparoscopy where the use of epidurals, previously common in abdominal surgery, has been questioned. 5 Interest in the use of local anesthetics via anatomical blocks, or by other routes, has grown recently.…”

mentioning

confidence: 99%

“…Opioid drugs are effective analgesic agents, however, they prolong recovery due to their significant complication profile which includes postoperative nausea and vomiting, delayed gastrointestinal transit, and ileus 1–3 . After surgery there is also an increased risk of developing opioid dependency which is why opioid usage in the perioperative setting should be limited 4 …”

mentioning

confidence: 99%

Intravenous Local Anesthetic Compared With Intraperitoneal Local Anesthetic in Laparoscopic Colectomy

et al. 2021

View full text Add to dashboard Cite

Introduction: Controlling perioperative pain is essential to improving patient experience and satisfaction following surgery. Traditionally opioids have been frequently utilized for postoperative analgesia. Although they are effective at controlling pain, they are associated with adverse effects, including postoperative nausea, vomiting, ileus, and long-term opioid dependency. Following laparoscopic colectomy, the use of intravenous or intraperitoneal infusions of lidocaine (IVL, IPL) are promising emerging analgesic options. Although both techniques are promising, there have been no direct, prospective randomized comparisons in patients undergoing laparoscopic colon resection. The purpose of this study was to compare IPL with IVL. Methods: Double-blinded, randomized controlled trial of patients undergoing laparoscopic colonic resection. The 2 groups received equal doses of either IPL or IVL which commenced intra-operatively with a bolus followed by a continuous infusion for 3 days postoperatively. Patients were cared for through a standardized enhanced recovery after surgery program. The primary outcome was total postoperative opioid consumption over the first 3 postoperative days. Patients were followed for 60 days. Results: Fifty-six patients were randomized in a 1:1 fashion to the IVL or IPL groups. Total opioid consumption over the first 3 postoperative days was significantly lower in the IPL group (70.9 mg vs 157.8 mg P < 0.05) and overall opioid consumption during the total length of stay was also significantly lower (80.3 mg vs 187.36 mg P < 0.05. Pain scores were significantly lower at 2 hours postoperatively in the IPL group, however, all other time points were not significant. There were no differences in complications between the 2 groups. Conclusion: Perioperative use of IPL results in a significant reduction in opioid consumption following laparoscopic colon surgery when compared to IVL. This suggests that the peritoneal cavity/compartment is a strategic target for local anesthetic administration. Future enhanced recovery after surgery recommendations should consider IPL as an important component of a multimodal pain strategy following colectomy.

show abstract

Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections

Karlsdottir

Wahba

et al. 2022

Int J Colorectal Dis

View full text Add to dashboard Cite

With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses. MethodsA retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay. ResultsFive hundred and ninety-two patients: 46% male, median age 58 years undergoing colorectal resections for indications including cancer, in ammatory bowel disease, and diverticulitis were identi ed. Less opioid use was found to be associated with female gender (β = -42), patients who received perioperative lidocaine infusion (β = -30), and older adults (equivalents/year) (β = -4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use and smoking were all independently associated with increased postoperative opioid requirements. ConclusionsIn this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.

show abstract

Tackling the opioid epidemic: Reducing opioid prescribing while maintaining patient satisfaction with pain management after outpatient surgery

Cited by 12 publications

References 16 publications

Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery

Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery

Intravenous Local Anesthetic Compared With Intraperitoneal Local Anesthetic in Laparoscopic Colectomy

Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections

Contact Info

Product

Resources

About