Opioid Use After Gynecologic Surgery Reduced With Prescription Protocol

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The use of UROPP did not appear to affect pain scores or patient satisfaction levels.
The use of UROPP did not appear to affect pain scores or patient satisfaction levels.

An ultra-restrictive opioid prescription protocol (UROPP) reduced opioid use by 85% among patients who underwent gynecologic surgery, according to an oral presentation at the 2018 Society of Gynecologic Oncology Annual Meeting on Women's Cancer in New Orleans.1

For this study, a UROPP was implemented between June and September, 2017 for 99 patients undergoing gynecologic surgery. Opioids were not prescribed to patients who underwent minimally invasive surgery (MIS), except for those who required 5 or more doses of oral or intravenous (IV) opioids and for patients who underwent laparotomy. These patients were given only a 3-day post-discharge supply. Outcomes were compared with those of the 626 patients from the previous year.

UROPP significantly reduced the number of short-acting opioids prescribed post-operatively: patients were given a mean 5.1 short-acting opioids at discharge compared with 31.7 for patients who underwent surgery the prior year (P < .001); the total number opioid prescriptions in the perioperative period was 16.3 vs 51.4 among patients post- vs pre-UROPP, respectively (P < .001).

Post-UROPP, the mean number of short-acting opioids prescribed after laparotomy was 12.3 compared with 43.6 pre-UROPP, and the total number of tablets in the perioperative period decreased to 18.1 from 68.1 (P < .001).

There were no reported changes in pain scores after surgery. Only 3% of patients requested refills after UROPP implementation.

The authors concluded that UROPP decreased opioid use “without changes in pain scores, patient satisfaction, or increase in medication refills.”


Mark JE, Phoenix D, Gutierrez CA, et al. Tackling the opioid crisis: implementation of an ultra-restrictive opioid prescription protocol in patients undergoing major gynecologic surgery radically decreased dispensed opioid without reducing pain control. Oral presentation at: 2018 Society of Gynecologic Oncology Annual Meeting on Women's Cancer; March 24-27, 2018; New Orleans, LA.

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