J. A. Balch1, J. S. Lee1,2, V. Parashar1,2, J. B. Miller3, S. M. Bremmer1,2, J. V. Vu1,2, L. A. Dossett1,2 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Center For Health Outcomes And Policy,Ann Arbor, MI, USA 3University Of Michigan,Center For Bioethics & Social Sciences In Medicine,Ann Arbor, MI, USA
Introduction:
Multiple studies demonstrate that opioid prescriptions far exceed patient consumption after surgery. These excess opioids can be inappropriately used or diverted for nonmedical use, thereby contributing to the national epidemic of opioid-related morbidity and mortality. Cancer patients are at particular risk for chronic pain and opioid use, and have higher rates of persistent opioid use after curative-intent surgery. To more accurately assess the amount of opioid needed postoperatively in cancer patients, we systematically reviewed the literature to evaluate opioid consumption in cancer patients after curative-intent surgery.
Methods:
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify studies describing opioid consumption in cancer patients after curative-intent surgery. The primary outcome was the amount of opioid consumed within 24 hours after the operation concluded. Reported opioid amounts were converted to oral morphine equivalents (OME) for comparison. Three reviewers independently screened studies for inclusion, extracted data, and assessed study quality.
Results:
Of the 31 studies reviewed in full, sixteen eligible studies reported opioid consumption for five types of curative-intent procedures, including breast, gynecologic, colorectal, renal, and lung cancer. We used 24 hours as a time point as this number represents peak postoperative opioid consumption. The amount of opioid consumed in this time point varied widely across surgical disciplines, ranging from 4 OME for breast cancer to 208 OME for gynecologic cancer (Figure1). Within each discipline, the amount of opioids consumed also varied widely depending on the use of non-opioid analgesics, peripheral nerve blocks, and epidural analgesia. For example, for breast cancer, the study group with the lowest reported opioid consumption (4 OME; Albi-Feldzer 2013) used scheduled acetaminophen and ketoprofen. In contrast, the breast cancer study group with the highest opioid consumption (72 OME; Terkawi 2014) had no standardized protocol for non-opioid analgesics.
Conclusion:
In cancer patients undergoing curative-intent surgery, opioid consumption varies widely depending on the use of non-opioid analgesics, peripheral nerve blocks, and epidural analgesia. Standardized pain management protocols may reduce variation in opioid consumption and minimize excessive opioid prescribing.
