Ultrarestrictive Opioid Prescription Protocol May Effectively Manage Postoperative Pain
All gynecological oncology patients who underwent surgery from July 2016 to June 2018 at a tertiary care cancer center in New York were included in the study.
Implementation of an ultrarestrictive protocol for opioid prescriptions was found to be associated with reductions in the amount of opioids prescribed after abdominal and gynecologic surgery, with no increases in refill requests, complications, or pain scores in the postoperative period, according to study results published in JAMA Network Open.
In this retrospective control and prospective case-cohort study, researchers sought to evaluate the efficacy of an ultrarestrictive opioid prescription protocol (UROPP) for the management of acute postsurgical pain. All gynecological oncology patients who underwent surgery from July 2016 to June 2018 at a tertiary care cancer center in New York were included in the study, with 626 pre-UROPP patients who underwent surgery between July 2016 and June 2017, and 605 post-UROPP participants who underwent surgery between June 2017 and June 2018.
After UROPP implementation, patients who underwent minimally invasive surgery or ambulatory surgery were not given prescriptions for opioids at discharge unless they had required >5 doses of intravenous or oral opioids while inpatient, and patients who underwent laparotomy were given a 3-day supply of opioids at discharge. Primary outcomes were the number requests for opioid refills during the 30-day postoperative time period and mean pain scores 2 weeks post-surgery.
UROPP implementation led to a reduction in the mean number of opioid pills supplied at discharge in patients who underwent: minimally invasive surgery (38.4±17.4 to 1.3±3.7, respectively; P <.001); ambulatory surgery (13.9±16.6 to 0.2±2.1, respectively; P <.001); laparotomy (43.6±17.0 to 12.1±8.9, respectively; P <.001). Perioperative opioid use decreased from 339.4±674.4 mg pre-implementation to 64.3±207.2 mg post-implementation in opioid-naive patients across all surgery types examined (P <.001).
The significant reduction in dispensed opioids in post- vs pre-UROPP implementation groups was not associated with increases in: mean postoperative pain scores (1.1±2.2 vs 1.4±2.3, respectively; P =.06), refill requests (16.5% vs 16.6%, respectively; P =.99), or number of complications (4.8%, n=29 vs 6.7%, n=42, respectively; P =.15).
"Using UROPP to manage postsurgical pain after discharge did not result in any negative health consequences; thus, we advocate for adopting radical opioid-sparing approaches for managing postoperative pain nationwide. This change in practice is expected to reduce health care costs and the number of opioids circulating in our communities," concluded the study authors.
Mark J, Argentieri DM, Gutierrez CA, et al. Ultrarestrictive opioid prescription protocol for pain management after gynecologic and abdominal surgery [published online December 7, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.5452