Post-operative Narcotic Use in the Elective General Surgery Population Developing Guidance for Prescribers
*Brett Baker, *John F. Kelly, *Max Hazeltine, *Olivia Karcis, *Sardis Harward, Richard Perugini
University of Massachusetts Medical School, Worcester, MA
Objective To elicit average narcotic needs in the elective, outpatient general surgery population for patients undergoing laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), laparoscopic ventral hernia repair (LV). In addition, using demographics, medical history, and intra-operative data, we hope to generate a reproducible model for predicting narcotic needs.
Design Observational study. Consented before surgery. All patients prescribed narcotic tablets post-operatively according to attending surgeon preference. At follow-up, patients questioned regarding post-operative pain control.
Setting Ambulatory surgery, academic medical center.
Patients (or Other Participants) Elective, ambulatory laparoscopic cholecystectomy, inguinal hernia, and ventral repair.
Interventions None.
Main Outcome Measures Narcotics prescribed/used, ER/clinic for pain complaints, disposal of excess tablets, mechanism of disposal, use “partial fill.”
Results All narcotics expressed as oxycodone 5mg equivalents. LC (n=14): mean usage 2.4 (range 0-8), mean prescribed 14.6 (10-20), mean excess 12 (3-20) LIH (n=15): mean usage 6.5 (range 0-20), mean prescribed 17.3 (10-25), mean excess 11.2 (0-25) LV (n=6): mean usage 10.3 tablets (range 0-44*), mean prescribed 15.3 (5-30), mean excess 7.3 (0-15) *patient used excess tablets from previous surgery There is no difference in the amounts of narcotic equivalents prescribed between the procedures studied. However, there is a difference in the total narcotic usage.
Conclusions Narcotic prescriptions following elective surgery routinely exceed requirements. In addition, prescriptions are not tailored specifically to the procedure performed. We plan to apply this model to other surgical procedures in to develop a model to “right size” prescriptions and reduce narcotics available for diversion. Institution-level efforts to dispose of unused narcotics could reduce opiate diversion and should be strongly pursued by hospitals nationwide. Further investigations include multimodal pre- and postoperative pain control regimens.
