Guidelines to control opioid prescribing for post-surgery pain

A recent study, conducted at Dartmouth-Hitchcock Medical Center in Lebanon, NH, suggests that more vigilant prescribing guidelines could reduce the number of opioid pills a patient receives after surgery, whilst still meeting pain management needs.

Credit: David Smart/ Shutterstock.com

Effective pain management after surgery is important both for patient comfort and to promote recovery and rehabilitation. Post-surgical pain relief is typically given in the form of an opioid drug, to block the sensation of pain and a non-steroidal anti-inflammatory drug, to reduce the inflammatory activity that exacerbates pain.

Such prescriptions must be managed with care since all have the potential to cause side-effects, which can set back recovery. There has been particular concern about the upsurge in opioid prescription since over-prescribing an opioids on discharge from hospital can open up possibilities of misuse and addiction.

Since there are few data to support the correct level of opioid prescribing for patients who are discharged after a hospital admission for a surgical procedure, a study was conducted to assess current prescribing practice. Over 300 hospital inpatients discharged after undergoing a general surgical procedure on the stomach, liver, or pancreas were surveyed.

The data showed that patients typically took only a fraction of the opioids prescribed for them at discharge from hospital. The majority of patients were prescribed an opioid yet only 38% of the prescribed opioid pills were taken.

More than half of the patients who took more than the recommended number of opioids took them for reasons other than pain control, eg, to help them sleep better, because they thought they should take all the pills given to them.

Lead study author DR Richard Barth explained "We specifically looked at the number of opioid pills that surgical inpatients took the day before discharge from the hospital, and we found that this number was the strongest predictor of how many opioid pills the patients would use after discharge"

DR Richard J Barth Jr., Dartmouth-Hitchcock Medical Center

The recommendations based on the findings of this study state that the post-discharge prescription for pain relief should be determined by the number of opioid pills taken the day before discharge. Patients taking no opioid drug the day before they left the hospital should not receive a prescription for an opioid drug; those who took one to three pills should receive 15 tablets, those who took four or more should be given 30 opioid tablets.

Dr Barth highlighted that "This guideline was true for multiple different operations. It didn't matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied".

Had these guidelines been followed for the patients evaluated in the study, up to 40% fewer opioid pills could have been prescribed whilst still meeting patients' pain management needs.

The guideline has already been adopted at Dr Barth's institution and is easy for other surgical centres to implement.

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