December 12, 2017

Surgeons cut opioid prescriptions dramatically, with no increase in pain

Guidelines developed from gallbladder patient data and interviews form the basis of a new effort to right-size opioid prescribing for many operations

Cutting opioid prescriptions

Some surgeons might be able to prescribe a third of opioid painkiller pills that they currently give patients and not affect their level of post-surgery pain control, a new study suggests.

That would mean far fewer opioids left over to feed the ongoing national crisis of misuse, addiction and overdose.

The findings, published in JAMA Surgery by a team from the University of Michigan, show the power of basing surgery-related pain prescriptions on how patients actually use medicines, and educating both surgical teams and patients on pain control. The U-M team recently launched a site aimed at doing just that.

It all started with a medical student and a resident. By the time it was done, Michigan Medicine surgical teams had dramatically cut the amount of opioid painkillers they prescribed.

Because no national guidelines exist for surgery-related pain control with opioids, the team set out to develop some and test them. They started with a common operation: gallbladder removal, or laparoscopic cholecystectomy.

Data from 170 patients treated at Michigan Medicine, U-M’s academic medical center, showed the average patient received a prescription of 250 milligrams of opioid medications, as measured in morphine equivalents. That’s about 50 pills.

But when the researchers interviewed 100 of these patients, the amount of opioid painkiller they’d actually taken after the operation averaged 30 milligrams, or about six pills. The rest was often still sitting in their medicine cabinets, even years after surgery.

When U-M surgical leaders heard these findings, they gave the researchers the green light to develop and roll out a much lower prescribing guideline, paired with a new patient education effort about pain control.