Approximately 6% of opioid-naïve patients will develop an opioid addiction after surgery. In a study presented at the 2018 American Society of Clinical Oncology (ASCO) Quality Care Symposium, researchers at Stanford Health Care unveiled a novel regimen for managing postsurgical pain without opioids. “In the nationwide effort to combat the opioid epidemic, healthcare providers can play a pivotal role as gatekeepers by decreasing reliance on opioids in the postoperative period,” noted the authors.

Over the course of 4 months, the researchers retrospectively reviewed daily opioid use, pain scores, and anxiety scores from patients recovering from surgery for urologic cancer and identified causes contributing to excess opioid use. They developed opioid-sparing pain regimens using various combinations of acetaminophen, ketorolac, gabapentin, and local anesthetic. The researchers held interventions to inform providers and nurses about alternative nonopioid medications, and eventually a program testing these alternative medications was later implemented.

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Of the 443 patients involved in the study, the median opioid use per patient decreased by 46% from a baseline morphine equivalent daily dose (MEDD) of 95.1 to 51.5. Patients’ 24 to 48 hour postsurgery pain scores did not increase. In addition, no changes were seen in anxiety scores for patients on an opioid-minimizing pain regimen 24 to 48 hours postsurgery. This successful reduction in opioid use for pain management was observed across multiple surgery types ranging from robotic prostatectomy to open radical cystectomy. 

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Stevenson K, Kee J, Van Zyl E, Dugala A, Bakul Shah J. Reducing opioid utilization after urologic oncology surgery. Oral presentation at: 2018 ASCO Quality care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 269.