Study finds new approach to manage post surgical pain with less opioids

A new study published in the JAMA Network Open has reported that post-surgical pain can be effectively managed with minimal or no opioids.

The study revealed that the number of opioid medications prescribed after surgery can be drastically reduced without negatively affecting pain scores, postoperative complications or patient requests for additional opioids, demonstrating that alternative approaches to pain management can be both safe and highly effective.

Jaron Mark and associates conducted a case-control cohort study evaluating whether, after hospital discharge, postsurgical acute pain can be effectively managed with a markedly reduced number of opioid doses.

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The cohort study included 1231 patients undergoing gynecologic oncology surgery. Patients undergoing ambulatory or minimally invasive surgery (laparoscopic or robotic approach) were not prescribed opioids at discharge unless they required more than 5 doses of oral or intravenous opioids while in the hospital. Patients who underwent a laparotomy were provided a 3-day opioid pain medication supply at discharge.

The study found that during its first year alone, the restrictive protocol eliminated the circulation of 16,374 opioid tablets (5 mg oxycodone equivalent), significantly reducing the volume of opioids that could be misused or diverted. The results of the full two-year study in 1,231 patients demonstrated that because postoperative pain can be managed effectively without opioids for minor or minimally invasive surgical procedures or with only a three-day supply for major surgery, the risks of chronic opioid misuse can be managed by reducing or eliminating opioid prescriptions in the first place.

"Using ultra-restrictive opioid prescription protocol (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, "write the authors.

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The study concluded that the implementation of UROPP in a large surgical service is feasible and safe and was associated with a significantly decreased number of opioids dispensed during the perioperative period, particularly among opioid-naive patients.

Opioids are routinely prescribed for postoperative home pain management for most patients with limited evidence of the amount needed to be dispensed. Opioid-based treatment often adversely affects recovery. Prescribed opioids increase the risk of chronic opioid use, abuse, and diversion and contribute to the current opioid epidemic.

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https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2717556