Dartmouth-Hitchcock study: You need fewer opioids after surgery than you think

Monitor staff
Friday, December 01, 2017

Patients who have major abdominal surgery should be able to control their pain at home by taking the same number of opioids that they did the day before they were discharged, according to a study that offers this measure as a guideline for post-surgery prescriptions.

The study, by Dartmouth-Hitchcock’s chief of surgery, Dr. Richard Barth, was published in the Journal of the American College of Surgeons.

“The guideline was based on satisfying at least 85 percent of patients’ home opioid requirement,” Barth said in a press release from Dartmouth-Hitchcock.

“It didn’t matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied,” Barth said.

The goal, he said, was to have guidelines for post-surgery prescriptions “that are easy to remember and easy to use” for providers and patients.

This is the first time specific guidelines have been proposed for prescribing opioids upon discharge after general surgery operations that require inpatient admission, according to the peer-reviewed Journal article.

Barth noted that several New England states limit doctors to prescribing a seven-day supply of opioids, but they include no limits on dosing. “A seven-day supply could be 84 pills or 21 pills,” he said.

Rising rates of opioid prescriptions have been linked to the national epidemic, and a significant number of opioid deaths have been linked to prescriptions written by surgeons.

Barth and his research team previously ran studies showing that most outpatient surgeries for breast, gall bladder and hernia repair needed far fewer opioid pain medications than currently prescribed, saying that a regimen of acetaminophen and ibuprofen could control 85 percent of post-surgical pain. Dartmouth-Hitchcock said this regimen produced “a 53 percent reduction in opioid use by surgical outpatients.”

The new study included 333 hospital inpatients discharged to home after six types of general surgery operations: bariatric procedures; operations on the stomach, liver, and pancreas; ventral hernia repair; and colon operations. The researchers followed up with the patients after discharge by using questionnaires and phone surveys; 90 percent of the discharged patients completed the follow-up process.

The study group did not include any chronic opioid users.

Barth says other Dartmouth-Hitchcock departments will study the recommendations in the coming year.