An ultrarestrictive opioid prescribing strategy was associated with a reduction in the number of pills dispensed in a study of patients having surgery for gynecologic cancer, without changes in postoperative pain scores, complications or increases in prescription refill requests.
Under the protocol, patients having ambulatory or minimally invasive surgery weren't prescribed opioids at discharge unless they required more than five doses of oral or intravenous opioids while in the hospital. Surgical patients who had an abdominal incision (laparotomy) were given a three-day supply of opioids when they were discharged. The average number of opioid pills dispensed at discharge decreased after the ultrarestrictive prescribing protocol was implemented from 43.6 to 12.1 for patients who had a laparotomy; from 38.4 to 1.3 for patients who had minimally invasive surgery; and from 13.9 to 0.2 for patients who had ambulatory surgery. The findings reveal a promising strategy for decreasing postoperative opioid prescribing without increasing pain.