Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway

Abstract

Opioids are overprescribed after surgery, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgery. Patients undergoing six procedures were offered the opportunity to participate in an opioid-sparing pain management pathway. Patients were advised to use acetaminophen and ibuprofen, and were provided with a small “rescue” opioid prescription for breakthrough pain. They were then surveyed postoperatively regarding opioid use and patient-reported outcome measures. Overall cohort characteristics and differences between opioid users and non-users were analyzed. A total of 190 patients were analyzed. Median (IQR) prescription size was 5 (4–6) pills and opioid use was 0 (0–4) pills. 52% of patients used no opioids after surgery. Median (IQR) leftover pills was 2 (0–5). Median (IQR) pain score was 1 (1–2) and satisfaction score was 10 (8–10). Almost all (91%) of patients agreed that their pain was manageable. Patients who used opioids were younger (52±14 vs. 59±13 years, P=0.001), reported higher pain scores (2 (1–2) vs. 1 (1–2), P=0.014), received larger rescue prescriptions (6±3 vs. 4±4 pills, P=0.003), and were less likely to agree that their pain was manageable (82% vs. 98%, P=0.001). There were no other significant differences between opioid users and non-users. Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway while still reporting high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids following discharge after minor surgery.