Open Access

ARTICLE

Simple frameshifts in minimally invasive surgery postoperative pain management significantly reduce opiate prescriptions

Thenappan Chandrasekar^1,*, Lydia Glick², Daniella Wong², Timothy M. Han², Joon Yau Leong², Misung Yi³, James R. Mark¹, Mark J. Mann¹, Edouard J. Trabulsi¹, Costas D. Lallas¹

1 Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
3 Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
* contributed equally
Address correspondence to Dr. Thenappan Chandrasekar, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia PA 19107 USA

Canadian Journal of Urology 2020, 27(3), 10250-10256.

Abstract

Introduction: To evaluate the impact of an “opt-in” non-narcotic postoperative pain regimen on narcotic utilization and patient-reported pain scores.
Materials and methods: A prospective, non-blinded pre- and post-interventional trial was conducted, including a lead-in period for baseline evaluation. The intervention group received a new pain protocol prioritizing non-narcotic medications, an “opt-in” requirement for opiates, and standardized patient education. Study outcomes included opiate prescription and utilization (measured in Morphine Equivalent Doses) and reported pain scores on postoperative day (POD) 1, discharge, and follow-up.
Results: At discharge, 70% fewer patients were prescribed any opioids (ARR: -0.7; p < 0.001); the amount prescribed was reduced by 95% (pre-intervention 69.3 mg versus post-intervention 3.5 mg, p < 0.001). Mean opioids used following discharge decreased by 76% (14.7 mg versus 3.5 mg, p = 0.011). In a subgroup analysis of robotic prostatectomies, there was a 95% reduction in mean opioids prescribed at discharge (64.6 mg versus 3.2 mg, p < 0.001) and 82% reduction in utilization over entire postoperative course (87.6 mg versus 15.7 mg, p = 0.001). There was no significant difference in pain scores between intervention groups at POD 1, discharge, and follow-up for patients (entire cohort and post-prostatectomy).
Conclusion: A standardized pain protocol with “opt-in” requirements for opiate prescription, emphasis on non-narcotic medications, and patient education, resulted in significant reductions in opioid use. Simple frameshifts in pain management can yield significant gains in the opioid epidemic.

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