As surgeons balance the need to control their patients ’postoperative pain with the risk that normal activity may be a gateway to long-term opioid use or addiction, a new study shows the power of method workers who take a moderate route.
In a new letter JAMA Surgery, a team from Michigan Medicine at the University of Michigan reports results from a study of 620 patients who underwent surgery in hospitals across Michigan, that their painkiller use was monitored, and conducted studies within one or three months after their works.
Half of the patients received preoperative counseling that emphasized non-opioid pain treatment as their first choice. Some patients in this group received small, “just unknowingly” prescriptions, but a third did not receive any opioid medication after surgery.
The other patients received routine care – meaning they received the usual amount of opioids dispensed after these operations. Not only did all patients in that group receive an opioid prescription, these prescriptions tended to be greater than those in the other group. And most patients did not take them all – leaving extra pills that could endanger the patient or others in their home if taken inappropriately, or move to illegal use.
Patients in both groups had the same operations – gallbladder removal, complete or partial thyroid removal or hernia repair. But despite the difference in painkiller use, patients in both groups were equally satisfied with their care and reported a similar quality of life when contacted later. And those in the opioid-sparing group said they suffered less pain overall.
First author Maia Anderson, MD, a resident of the UM Department of Surgery, says, “It is so interesting to think about the potential for postoperative opioid pathways to not only reduce the risk of opioids for our patients, but also to significantly reduce the risk of opioid transmission into our communities. ”
Lead author and surgical resident Ryan Howard, MD, said, “We know that opioids are a major risk to patients after surgery. We can protect patients from these risks by minimizing them. or discontinuing opioids after surgery, but this is always a concern that patients have uncontrolled pain and feel unwell.This study suggests that That’s not true – patients who receive small-scale opioid prescriptions, or even without a prescription, are just as satisfied with their treatment after surgery. ”
Anderson and Howard worked with three UM School of Medicine faculties that lead the Michigan Opioid Order and Participation Network – Chad Brummett, MD, Jennifer Waljee, MD, MPH, MS and Michael Englesbe, MD – and with Alex Hallway, BS, is a member of the program’s staff who coordinates the effort to prescribe size-related surgery opioids in Michigan. Michigan-OPEN has published evidence-based prescribing guidelines for many procedures, as well as materials to support the education of opioid-depressed patients.
The study used data from the Michigan Medical Quality Consortium working to improve surgical care in 70 hospitals across Michigan. Anderson and Howard are partners at the UM Center for Healthcare Outcomes and Policy.
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