In the wake of the opioid crisis in the United States, a group of surgeons from Michigan Med formed a study to explore the possibility of postoperative pain management strategies with reduced or no opioids.
The author and lead of the study is Michael Englesbe, M.D., FACS, a U-M Institute for Healthcare Policy and Innovation health services researcher. He is also a University of Michigan Professor of Surgery, and has spent the last two years working on improving opioid prescriptions in the state of Michigan.
We think a fundamental root cause of the opioid epidemic is opioid-naïve patients [with no history of opioid usage] getting exposed to opioids and then really struggling to stop taking them postoperatively, and then moving on to chronic opioid use, abuse, addiction, and overdose.Michael Englesbe, M.D., FACS, on the U.S. opioid crisis (Michigan Medicine)
The study included 190 opioid-naïve patients undergoing the following surgical procedures:
- Laparoscopic cholecystectomy
- Laparoscopic inguinal hernia repair
- Robotic prostatectomy
- Endoscopic sinus operations
- Laparoscopic sleeve gastrectomy
For pre-op visits, patients were instructed to take acetaminophen or ibuprofen every six hours. They were also counselled on pain expectations and management without opioids. After their operations, they received prescriptions for acetaminophen and ibuprofen, along with a small “rescue” opioid prescription for breakthrough pain.
Patient reports detailed their pill intake and pain for between 30 to 90 days. Findings revealed that they used little to no opioids for post-op pain management. They also indicated they were highly satisfied with the prescribed pain therapies. According to the author, 52% of patients did not take opioids post-op, and 98% used 10 pills or fewer in total.
But pain management doesn’t boil down to the exclusion of opioids. It’s about overall pain care, and this is the first step in reducing opioid dependency and finding alternatives in other drug therapies and counselling.