Prescribing fewer opioid pills after surgery and providing opioid use education before surgery may reduce postoperative opioid consumption, according to study results published in JAMA.
A total of 264 patients (mean age, 25 years; 49% men) undergoing anterior cruciate ligament reconstruction at a single academic center were assigned to receive 50 tablets of percocet (n=109), 30 tablets of percocet (n=77), or 30 tablets of percocet plus preoperative education on opioid use (n=78). The education module covered appropriate opioid use and alternative pain control strategies. There were no significant demographic differences between the groups.
Patients who received 50 tablets took a mean of 25.4 tablets, compared with a mean of 15.6 tablets in patients who received 30 tablets and no education (P <.001). Participants who received 30 tablets and no education took opioids for fewer postoperative days than patients who were prescribed 50 tablets (4.5 days vs 5.8 days, respectively; difference, 1.2 days; 95% CI, 0.09-2.4 days).
Participants who received 30 percocet tablets plus education vs no education consumed fewer opioids (12.4 vs 15.6 tablets, respectively; P =.02), and for fewer days after surgery (3.5 vs 4.5 days, respectively; difference, 1.0 day; 95% CI, 0.2-1.9). Patients who received 30 vs 50 tablets experienced less constipation and fatigue, and there were no between-group differences in the number of prescription refills.
Study limitations include recall bias related to the survey-based design.
“In this study, half of prescribed opioids were consumed in each group, suggesting that prescribing even less might further reduce opioid use. Further investigation should evaluate whether similar opioid stewardship and education protocols would be successful in other patient populations,” concluded the study authors.
Farley KX, Anastasio AT, Kumar BA, Premkumar A, Gottschalk MB, Xerogeanes J. Association between quantity of opioids prescribed after surgery or preoperative opioid use education with opioid consumption [published online June 25, 2019]. JAMA. doi:10.1001/jama.2019.6125