The NOpioid Project: a prospective observational feasibility study examining the implementation of a non-narcotic post-operative pain control regimen.
Acute care surgery
Emergent laparoscopic appendectomy/cholecystectomy
Non-narcotic pain protocol after surgery
Patient-reported pain scores
Quality of life
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
07
09
2021
accepted:
15
02
2022
pubmed:
6
3
2022
medline:
1
11
2022
entrez:
5
3
2022
Statut:
ppublish
Résumé
Post-operative prescription of opioids has fueled an increase in opioid-associated morbidity and mortality. Alternative post-operative pain control with non-opioid pharmaceuticals can help counteract this effect. We investigated a non-opioid pain management protocol following emergent laparoscopic appendectomy and laparoscopic cholecystectomy. Our tertiary referral center performed a prospective observational feasibility study of patients from October 2019 to 2020 who underwent emergent laparoscopic appendectomies and cholecystectomies. Patients aged 18-65 with no prior history of chronic pain or opioid abuse, no contraindications to taking acetaminophen and ibuprofen, and Glomerular Filtration Rate > 60 ml/min were included. Counseling was provided about non-narcotic pain control. Patients were not prescribed narcotics at discharge and were instead prescribed ibuprofen and acetaminophen. Patients were surveyed at their 2-week post-operative appointment to assess pain control and other patient-reported outcomes, including quality of life (QOL). Fifty-one patients met the inclusion criteria and completed the postoperative survey. Thirty-two were female (63%), average age 38, and BMI 30.4. 30 (59%) underwent laparoscopic appendectomy for acute non-perforated appendicitis and 21 (41%) underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic cholelithiasis. 88% of patients felt satisfied or neutral with their post-operative pain control at discharge. After 2 weeks, 34 patients (66.7%) rated QOL as high, 17 (33.3%) rated QOL as moderate, and none rated QOL as poor. Fascial suture was not associated with poor outcomes. Anxiety, depression, alcohol use, and prior abdominal surgery were not associated with increased need for post-operative narcotics. There were no significant differences between appendectomy and cholecystectomy in satisfaction with pain control or QOL (p > 0.05). Patients undergoing surgery have an increased risk of developing an opioid disorder. The NOpioid Project demonstrated a non-narcotic multimodal pain regimen can be effectively adopted in the post-operative period after an emergent laparoscopic appendectomy or emergent laparoscopic cholecystectomy.
Sections du résumé
BACKGROUND
Post-operative prescription of opioids has fueled an increase in opioid-associated morbidity and mortality. Alternative post-operative pain control with non-opioid pharmaceuticals can help counteract this effect. We investigated a non-opioid pain management protocol following emergent laparoscopic appendectomy and laparoscopic cholecystectomy.
METHODS
Our tertiary referral center performed a prospective observational feasibility study of patients from October 2019 to 2020 who underwent emergent laparoscopic appendectomies and cholecystectomies. Patients aged 18-65 with no prior history of chronic pain or opioid abuse, no contraindications to taking acetaminophen and ibuprofen, and Glomerular Filtration Rate > 60 ml/min were included. Counseling was provided about non-narcotic pain control. Patients were not prescribed narcotics at discharge and were instead prescribed ibuprofen and acetaminophen. Patients were surveyed at their 2-week post-operative appointment to assess pain control and other patient-reported outcomes, including quality of life (QOL).
RESULTS
Fifty-one patients met the inclusion criteria and completed the postoperative survey. Thirty-two were female (63%), average age 38, and BMI 30.4. 30 (59%) underwent laparoscopic appendectomy for acute non-perforated appendicitis and 21 (41%) underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic cholelithiasis. 88% of patients felt satisfied or neutral with their post-operative pain control at discharge. After 2 weeks, 34 patients (66.7%) rated QOL as high, 17 (33.3%) rated QOL as moderate, and none rated QOL as poor. Fascial suture was not associated with poor outcomes. Anxiety, depression, alcohol use, and prior abdominal surgery were not associated with increased need for post-operative narcotics. There were no significant differences between appendectomy and cholecystectomy in satisfaction with pain control or QOL (p > 0.05).
CONCLUSION
Patients undergoing surgery have an increased risk of developing an opioid disorder. The NOpioid Project demonstrated a non-narcotic multimodal pain regimen can be effectively adopted in the post-operative period after an emergent laparoscopic appendectomy or emergent laparoscopic cholecystectomy.
Identifiants
pubmed: 35246743
doi: 10.1007/s00464-022-09144-7
pii: 10.1007/s00464-022-09144-7
pmc: PMC8896850
doi:
Substances chimiques
Acetaminophen
362O9ITL9D
Ibuprofen
WK2XYI10QM
Analgesics, Non-Narcotic
0
Narcotics
0
Analgesics, Opioid
0
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8472-8480Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Buhcer-Bartelson B, Green JL (2015) Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. https://doi.org/10.1056/NEJMSA1406143.Jan2015
doi: 10.1056/NEJMSA1406143.Jan2015
pubmed: 25875268
Opioid Overdose Crisis | National Institute on Drug Abuse (NIDA). Available at https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis . Accessed on 18 Aug 2021
Provisional Drug Overdose Data. Available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm . Accessed on 02 Sep 2021
Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, Bohnert AS, Kheterpal S, Nallamothu BK (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. https://doi.org/10.1001/JAMASURG.2017.0504.June2017
doi: 10.1001/JAMASURG.2017.0504.June2017
pubmed: 28403427
pmcid: 5885924
Howard R, Fry B, Gunaseelan V, Lee J, Waljee J, Brummett C, Campbell D, Seese E, Englesbe M, Vu J (2019) Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg. https://doi.org/10.1001/JAMASURG.2018.4234.Jan2019
doi: 10.1001/JAMASURG.2018.4234.Jan2019
pubmed: 31017644
pmcid: 6583837
Hathaway A, Vu J, Lee J, Palazzolo W, Waljee J, Brummett C, Englesbe M, Howard R (2019) Patient satisfaction and pain control using an opioid-sparing postoperative pathway. J Am Coll Surg. https://doi.org/10.1016/J.JAMCOLLSURG.2019.04.020
doi: 10.1016/J.JAMCOLLSURG.2019.04.020
Knight AW, Habermann EB, Ubl DS, Zielinski MD, Thiels CA (2019) Opioid utilization in minimally invasive versus open inguinal hernia repair. Surgery. https://doi.org/10.1016/J.SURG.2019.05.012.June2019
doi: 10.1016/J.SURG.2019.05.012.June2019
pubmed: 31229314
Hartford LB, van Koughnett JAM, Murphy PB, Vogt KN, Hilsden RJ, Clarke CF, Allen LJ, Gray SD, Parry NG, Gray DK, Leslie KA (2019) Standardization of outpatient procedure (STOP) narcotics: a prospective non-inferiority study to reduce opioid use in outpatient general surgical procedures. J Am Coll Surg. https://doi.org/10.1016/J.JAMCOLLSURG.2018.09.008
doi: 10.1016/J.JAMCOLLSURG.2018.09.008
pubmed: 30359828
Hanson KT, Thiels CA, Polites SF, Gazelka HM, Ray-Zack MD, Zielinski MD, Habermann EB (2018) The opioid epidemic in acute care surgery—characteristics of overprescribing following laparoscopic cholecystectomy. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000001834.July2018
doi: 10.1097/TA.0000000000001834.July2018
pubmed: 29462081
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, Kvarstein G, Stubhaug A (2008) Assessment of pain. Br J Anaesth. https://doi.org/10.1093/BJA/AEN103.Jul2008
doi: 10.1093/BJA/AEN103.Jul2008
pubmed: 18487245
Larach DB, Waljee JF, Hu HM, Lee JS, Nalliah R, Englesbe MJ, Brummett CM (2020) Patterns of initial opioid prescribing to opioid-naive patients. Ann Surg. https://doi.org/10.1097/SLA.0000000000002969.Feb2020
doi: 10.1097/SLA.0000000000002969.Feb2020
pubmed: 30048311
Dowell D, Haegerich TM, Chou R (2016) CDC guidelines for prescribing opioids for chronic pain. CDC Morb Mortal Wkl Rep 65(1):1–49
Howard R, Vu J, Lee J, Brummett C, Englesbe M, Waljee J (2020) A pathway for developing postoperative opioid prescribing best practices. Ann Surg. https://doi.org/10.1097/SLA.0000000000003434.Jan2020
doi: 10.1097/SLA.0000000000003434.Jan2020
pubmed: 33177414
Opioid Prescribing Recommendations | Michigan OPEN. Available at https://michigan-open.org/prescribing-recommendations/ . Accessed on 02 Sep 2021
Hayes CJ, Krebs EE, Hudson T, Brown J, Li C, Martin BC (2020) Impact of opioid dose escalation on the development of substance use disorders, accidents, self-inflicted injuries, opioid overdoses and alcohol and non-opioid drug-related overdoses: a retrospective cohort study. Addiction. https://doi.org/10.1111/ADD.14940.June2020
doi: 10.1111/ADD.14940.June2020
pubmed: 31944486
pmcid: 7263736
Landsman-Blumberg PB, Katz N, Gajria K, Coutinho AD, Yeung PP, White R (2017) Burden of alcohol abuse or dependence among long-term opioid users with chronic noncancer pain. J Manag Care Spec Pharm. https://doi.org/10.18553/JMCP.2017.23.7.718.Jul2017
doi: 10.18553/JMCP.2017.23.7.718.Jul2017
pubmed: 28650247
Compton WM, Jones CM, Baldwin GT (2016) Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. https://doi.org/10.1056/NEJMRA1508490
doi: 10.1056/NEJMRA1508490
pubmed: 27806233
pmcid: 5247797
Cicero TJ, Ellis MS, Surratt HL, Kurtz SP (2014) The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiat. https://doi.org/10.1001/JAMAPSYCHIATRY.2014.366.July2014
doi: 10.1001/JAMAPSYCHIATRY.2014.366.July2014
Groenewald CB (2019) Opioid prescribing patterns for pediatric patients in the USA. Clin J Pain. https://doi.org/10.1097/AJP.0000000000000707.Jun2019
doi: 10.1097/AJP.0000000000000707.Jun2019
pubmed: 30985396
pmcid: 6782052
Buono K, Whitcomb E, Guaderrama N, Lee E, Ihara J, Sudol N, Lane F, Lee J, Heliker BD, Brueseke T (2021) A randomized controlled trial assessing the impact of opioid-specific patient counseling on opioid consumption and disposal after reconstructive pelvic surgery. Female Pelvic Med Reconstr Surg. https://doi.org/10.1097/SPV.0000000000001009
doi: 10.1097/SPV.0000000000001009
pubmed: 33620897
Lam L, Richardson MG, Zhao Z, Thampy M, Ha L, Osmundson SS (2021) Enhanced discharge counseling to reduce outpatient opioid use after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol. https://doi.org/10.1016/J.AJOGMF.2020.100286
doi: 10.1016/J.AJOGMF.2020.100286