When employed, the protocol drastically reduced the number of opioids prescribed after surgery, according to a new study.
Roswell Park Comprehensive Cancer Center used patient and specialist feedback to build new, data-driven guidelines that cut the number of opioids prescribed, managing pain after minimally invasive surgery with minimal or no opioids, according to a new study.
In the first year of the experiment, the new protocol eliminated the circulation of 16,374 opioid tablets. Ultimately, the new prescription protocol decreased the number of pills from 44 to 12 after major surgery, 38 to one after minimally invasive surgery and 14 to none after minor surgery — an overall reduction in opioids of 89 percent.
Lead author Emese Zsiros, M.D., Ph.D., department of gynecologic oncology at Roswell Park Comprehensive Cancer Center in New York, and her team developed an ultrarestrictive opioid prescription protocol based on patient feedback and recommendations from surgeons and pain specialists. The team discovered that postoperative patients used very little of their prescribed opioids and frequently inquired about returning unused pills.
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Because of the comments, the team tested whether opioids were necessary after minor or minimally invasive procedures.
The study lasted two years, and the new protocol was put in place during the second year. During that period, 605 surgical patients had pain that was managed using the protocol after hospital discharge, compared to 626 patients who had no new guidelines in place.
During the study, patients were not prescribed opioids at the time of discharge unless they required more than five doses while in the hospital. Those who had major surgery were given a three-day supply at discharge, unless they needed more during the last 24 hours of their hospital stay.
Any refill phone calls were tracked, and patients who called for the refill were triaged for an urgent postoperative visit if the pain was related to postsurgical complications. A three-day supply of 12 pills was provided for the refill, and there were no second refills given without a clinical evaluation.
Instead of opioids, patients were prescribed a pain regimen of ibuprofen and acetaminophen.
“Our study clearly shows that patients can recover from major surgery just as well with over-the-counter pain medications such as ibuprofen or acetaminophen and minimal or no opioids, with no increase in pain or postoperative complications — and without the side effects of opioids,” Zsiros said in a statement.
According to the Centers for Disease Control and Prevention, 116 people in the U.S. die per day after an opioid overdose and 40 percent of all deaths due to opioid overdose involve a prescription opioid.
Because of its success, the new restrictive protocol will go into effect throughout all Roswell Park surgical services starting in 2019.
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