Stevenson K, et al. - Given widespread abuse of opioid pain medications among Americans, with 6% of opioid-naïve patients becoming newly addicted to opioid medications following surgery, researchers aimed to lessen dependence on opioids to manage post-operative pain by 50% from a baseline morphine equivalent daily dose (MEDD) of 95.1 to a target of 47.5 MEDD. The implementation of opioid-minimizing approaches, including opioid-sparing pain regimens and interventions to facilitate adoption of the novel pathways, led to a reduction of 46% in opioid use following surgery without compromising pain control. To combat the opioid epidemic, health care providers can play a pivotal role by decreasing reliance on opioids in the post-operative period.

Methods

• Participants were inpatients recovering from surgery for urologic cancers at the researchers’ institution over 4 months.
• These subjects were retrospectively reviewed for daily opioid use, pain scores, and anxiety scores.
• The causes contributing to excess opioid use were determined by generating process maps, Ishikawa diagrams, and Pareto charts.
• Opioid-sparing pain regimens (using varying combinations of acetaminophen, ketorolac, gabapentin, and local anesthetic) were designed and key drivers needed to reliably reduce excess opioid use were also identified.
• They also implemented initial interventions aimed at educating providers and nurses on availability and efficacy of non-opioid medications, and later, to facilitate adoption of the novel pathways.

Results

• This QI project involved 443 patients.
• Findings revealed that the median opioid use per patient decreased 46% from 95.1 to 51.5 MEDD over the course of this project.
• Across multiple surgery types, ranging from robotic prostatectomy (55.1 MEDD) to open radical cystectomy (50.6 MEDD), this attenuation in opioid requirements was successfully achieved.
• They observed no increase in 24- or 48-hour post-operative pain score related to use of opioid-minimizing pathways (3.03 vs 3.04 and 2.92 vs 2.96, respectively; p > 0.05 for both).
• Similarly, no change was observed in anxiety score at 24- or 48-hours after surgery (0.15 vs 0.12 and 0.48 vs 0.30, respectively; p > 0.05 for both).