Striving for Evidence-Based Postoperative Opioid Prescribing While Optimizing Perioperative Pain Management—Shifting to Conservative Prescribing

Abstract

The study by Mark et al 1 presents the findings of a case-control cohort study of gynecologic oncology patients receiving ambulatory or minimally invasive surgery highlighting the effects of an ultrarestrictive opioid prescription protocol (UROPP). All patients receiving ambulatory or minimally invasive surgery were not prescribed opioids at hospital discharge unless they required more than 5 doses of oral or intravenous opioids in the 24 hours prior to discharge. Patients receiving laparotomy were prescribed either a 3-or 6-day supply of opioids at discharge based on whether they similarly required more than 5 opioid doses in the 24 hours prior to discharge. Overall, there were significant decreases in the mean number of opioid tablets prescribed at discharge comparing cases with controls after laparotomy (12.1 vs 43.6 tablets; P < .001), after major laparoscopic or robotic operations (1.3 vs 38.4 tablets; P < .001), and after ambulatory surgery (0.2 vs 13.9 tablets; P < .001). In the context of an overall 89% reduction in dispensed opioids, the UROPP did not increase the number of refill requests within the first 30 days, postoperative visit pain scores in the first 2 weeks, or postoperative complications.