A. K. Hallway2, J. Santos-Parker1, J. Lee1,2, J. Vu1,2, W. Palazzolo2, J. Waljee1,2, C. Brummett1, M. Englesbe1,2, R. Howard1,2 1University Of Michigan,Medical School,Ann Arbor, MI, USA 2University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction: Excessive opioid prescribing after surgery results in leftover medication being introduced into the community. Moreover, 5-20% of patients who receive an opioid prescription after surgery will become chronic opioid users. Minimizing post-operative opioid prescriptions may mitigate the risk of overdose, chronic opioid use, and reduce the number of opioids entering the community.
Methods: A pilot study was conducted in adult patients undergoing laparoscopic cholecystectomy at a single academic health system. A novel, opioid-sparing pathway (Pain-control Optimization Pathway [POP]) was utilized in which patients elect to receive education about managing their post-operative pain without opioids. Patients receive instructions for staggered non-opioid (ibuprofen and acetaminophen) pain management along with a “rescue dose” of 4 oxycodone tablets. These patients were then surveyed 30-90 days after surgery and compared to a statewide cohort of similar patients undergoing traditional laparoscopic cholecystectomy (non-POP) to assess medication use, satisfaction, regret, and pain.
Results: Of the 28 patients currently enrolled in POP, five have reached the 30-day post-operative time-point and responded to the survey. A statewide database of 100 non-POP patient responses were used for comparison. There were no significant differences in age or sex between groups. All POP patients received acetaminophen and ibuprofen and a rescue prescription of 4 oxycodone tablets (30 oral morphine equivalents [OMEs]). Non-POP patients received an average of 33±14 opioid tablets (200±138 OMEs; P<0.001). POP patients used an average of 0.8±1.8 tablets (6±13.5 OMEs) compared with 14±16 tablets (89±136 OMEs) in non-POP patients (P<0.001). 80% of POP patients did not use any opioids compared to 24% of non-POP patients. POP patients had 3.2±1.8 tablets (24±13.4 OMEs) remaining per patient while non-POP patients had 19±14 opioid tablets (111.0±90 OMEs) remaining per patient (P<0.001). 100% of POP patients indicated that their pain was manageable with the opioid-sparing model, with no significant differences in surgical site pain after surgery between groups. There were no significant differences in patient satisfaction or regret to undergo surgery between groups.
Conclusion: Opioid-sparing pain control resulted in lower opioid consumption, reduced leftover medication, and provided similar pain control and satisfaction compared to non-POP patients. These preliminary findings suggest that opioid-sparing pain management after surgery is a feasible strategy to eliminate excess pills from entering the community and possibly mitigate the risk of chronic opioid use.
