Pain after surgery can be effectively managed with minimal or no opioids, according to research conducted at Roswell Park Comprehensive Cancer Center and published today in JAMA Network Open. A two-year study by a multidisciplinary team of surgeons and other cancer specialists shows that the amount of opioid medications prescribed after surgery can be drastically reduced without negatively affecting pain scores, postoperative complications or patient requests for additional opioids, demonstrating that alternative approaches to pain management can be both safe and highly effective.
The publication presents the findings of a two-year pilot study at Roswell Park in which patients undergoing gynecologic or abdominal surgery were prescribed fewer opioids at discharge.
The impact of the pilot was striking. During its first year alone, the restrictive protocol eliminated the circulation of 16,374 opioid tablets (5 mg oxycodone equivalent), significantly reducing the volume of opioids that could be misused or diverted. The results of the full two-year study in 1,231 patients demonstrate that because postoperative pain can be managed effectively without opioids for minor or minimally invasive surgical procedures or with only a three-day supply for major surgery, the risks of chronic opioid misuse can be managed by reducing or eliminating opioid prescriptions in the first place.
Based on the success of the opioid-sparing approach to postsurgical pain management, the new restrictive protocol will go into effect throughout all Roswell Park surgical services beginning January 1, 2019. Roswell Park is believed to be the first cancer center in the U.S. to implement such a radical opioid-sparing policy so broadly. This change in practice is expected to reduce health care costs while protecting patients and the greater community from the risks associated with opioid use.
The study, “Ultrarestrictive Opioid Protocol for Pain Management After Gynecologic and Abdominal Surgery,” was supported by grants from the National Cancer Institute and by donations to Roswell Park. The published article is available at http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.5452.