Opioid Prescribing Suboptimal in Setting of Enhanced Recovery After Surgery

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"Physician behavior, rather than the condition of the patient, is the primary determinant of opioid prescribing practices.”
"Physician behavior, rather than the condition of the patient, is the primary determinant of opioid prescribing practices.”

A historical prospective study published in Anesthesia & Analgesia indicated that implementation of an enhanced recovery after surgery (ERAS) protocol resulted in an increase in opioid-free anesthesia and multimodal analgesia, but did not modify opioid prescribing practices.

Opioid-free and multimodal analgesia were compared in patients who underwent colorectal surgery the year prior to and the year after implementation of an ERAS intervention (n=194, and n=189, respectively).

Following the ERAS intervention, the rate of opioid prescriptions did not change significantly (P =.4); although opioid prescriptions decreased by 13%, the researchers noted that this was not significant (P =.1).

In patients with low pain scores at discharge, no preoperative opioid use, and low morphine milligram equivalents consumption before discharge, the opioid prescription rate at discharge was 72% (95% CI, 61%-83%).

The researchers concluded that their results suggest that "physician behavior, rather than the condition of the patient, is the primary determinant of opioid prescribing practices … and should be modified for opioid-free anesthesia and multimodal analgesia to impact the opioid epidemic."

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Reference

Brandal D, Keller MS, Lee C, et al. Impact of enhanced recovery after surgery and opioid-free anesthesia on opioid prescriptions at discharge from the hospital: A historical-prospective study. Anesth Analg. 2017;125(5):1784-1792. 

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