Opioids Aren't Always the Answer for Certain Post-Op Procedures

As more people in the United States become addicted or face opioid overdoses, health care professionals are starting to take a step back and re-evaluate their prescribing habits.

A group of researchers at the Roswell Park Cancer Institute recently found that most women who undergo laparoscopic or minimally invasive surgery for gynecologic cancers can manage their post-operative pain without the use of opioids.

Two factors sparked the inspiration for the study, according to Jaron Mark, M.D., a second-year gynecologic oncology fellow at Roswell Park. Not only was news of the opioid epidemic widespread in the media, but also, the treatment team at Roswell Park noticed that many of their patients who went home with a bottle of pills reported not using them all.

“A large number of them, specifically those who underwent minimally invasive surgery said that they didn't use any of the opioids that we prescribed,” Mark said in an interview with OncLive, a sister publication of CURE. “So, we thought about that, and with the opioid crisis being all over the news, we thought about how we could affect it.”

Providers in the gynecologic oncology department decided to stop prescribing opioids for patients who underwent laparoscopic, minimally invasive or outpatient ambulatory surgeries.

If patients were admitted to the hospital after their surgery or deemed to need opioids to manage their pain, they were only given a small amount — most got a three-day supply of 12 tablets. Otherwise, they were given ibuprofen and acetaminophen.

With this new protocol, they were able to drastically reduce the number of opioid pills prescribed per patient — going from an average of 31 per patient to about 1.

The researchers also tracked patients’ calls asking for more pain medication as well as their pain scores at follow-up appointments, of which neither increased.

“We had 337 patients on this new protocol and the data is striking. The patients are not calling and asking for refills. Their pain isn't sub-optimally managed,” Mark said.

Not taking opioids can spare patients from the side effects associated with the class of drug, such as constipation, nausea and unwanted sedation.

“You eliminate those by eliminating the opioids. After surgery, what patients need to do is get up and stay active. But if you're giving them an opioid, that makes them sleepy and want to sleep all day. That's not good for post-op recovery,” Mark said.

But even more importantly, a widespread decrease in opioid prescribing may lead to fewer cases of dependence on or overdosing from the drugs. According to the Centers for Disease Control and Prevention (CDC), an average of 115 Americans die each day from opioid overdose. And many of these people initially had the opioid prescribed to them.

The CDC also reported that between 1999 and 2010, the amount of opioids sold in pharmacies, hospitals and doctors’ offices quadrupled. However, there was not a decrease in the amount of overall pain reported by Americans.

“I think it's hard to break old habits. We think that the only way to control acute surgical pain is with an opioid. That's been the predominant theory,” Mark said.

After seeing success in the gynecologic oncology department, the researchers are currently working on moving their opioid policy to other surgery specialty groups. And if that goes well, maybe the policy will continue to move across the hospital — and the nation.

“I think once we can show this on a larger scale, then it's kind of a no-brainer that other institutions will follow suit,” Mark said.