Ultrarestrictive opioid prescription strategy results in fewer pills dispensed, no increase in pain

Editor's Note

In this study, an ultrarestrictive opioid prescribing strategy was associated with a reduction in the number of pills dispensed without changes in postoperative pain, complications, or increases in prescription refill requests.

In this case-control 2-year analysis of 1,231 women having surgery for gynecologic cancer, those having ambulatory or minimally invasive procedures weren’t prescribed opioids at discharge unless they required more than five doses while in the hospital. Those who had open abdominal incisions were given a 3-day supply of opioids when they were discharged.

The mean number of opioid pills dispensed at discharge decreased after the ultrarestrictive prescribing protocol was implemented from 43.6 to 12.1 for patients who had a laparotomy, from 38.4 to 1.3 for patients who had minimally invasive (laparoscopic or robotic) surgery, and from 13.9 to 0.2 for patients who had ambulatory surgery.

The significant reduction in the number of opioids dispensed was not associated with an increase in refill requests (104 patients before implementation vs 100 patients after), postoperative pain scores (1.4 before vs 1.1 after), or number of complications (42 before vs 29 after).

The findings show a promising strategy for decreasing postoperative opioid prescribing without increasing pain, the researchers say.