A Randomized Controlled Trial Assessing the Impact of Opioid-Specific Patient Counseling on Opioid Consumption and Disposal After Reconstructive Pelvic Surgery

Buono, Kristen; Whitcomb, Emily L.; Guaderrama, Noelani M.; Lee, Elizabeth; Ihara, Jun; Sudol, Neha T.; Lane, Felicia; Lee, Jennifer; Heliker, Bhumy Davé; Brueseke, Taylor

doi:10.1097/spv.0000000000001009

Cited by 12 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Proactive patient counseling has proven successful in other studies as well. For example, a 2021 study found in-hospital opioid counseling increased the disposal rate of unused opioids at 6 weeks post-surgery [ 20 ]. This reduces potential opioid misuse as there are fewer unused opioid pills in patients’ possession after surgery [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, a 2021 study found in-hospital opioid counseling increased the disposal rate of unused opioids at 6 weeks post-surgery [ 20 ]. This reduces potential opioid misuse as there are fewer unused opioid pills in patients’ possession after surgery [ 20 ]. A 2020 study reported that the frequency of proper opioid disposal doubled after counseling, and that overall knowledge of opioid risks increased [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The NOpioid Project: a prospective observational feasibility study examining the implementation of a non-narcotic post-operative pain control regimen

et al. 2022

View full text Add to dashboard Cite

Background Post-operative prescription of opioids has fueled an increase in opioid-associated morbidity and mortality. Alternative post-operative pain control with non-opioid pharmaceuticals can help counteract this effect. We investigated a non-opioid pain management protocol following emergent laparoscopic appendectomy and laparoscopic cholecystectomy. Methods Our tertiary referral center performed a prospective observational feasibility study of patients from October 2019 to 2020 who underwent emergent laparoscopic appendectomies and cholecystectomies. Patients aged 18–65 with no prior history of chronic pain or opioid abuse, no contraindications to taking acetaminophen and ibuprofen, and Glomerular Filtration Rate > 60 ml/min were included. Counseling was provided about non-narcotic pain control. Patients were not prescribed narcotics at discharge and were instead prescribed ibuprofen and acetaminophen. Patients were surveyed at their 2-week post-operative appointment to assess pain control and other patient-reported outcomes, including quality of life (QOL). Results Fifty-one patients met the inclusion criteria and completed the postoperative survey. Thirty-two were female (63%), average age 38, and BMI 30.4. 30 (59%) underwent laparoscopic appendectomy for acute non-perforated appendicitis and 21 (41%) underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic cholelithiasis. 88% of patients felt satisfied or neutral with their post-operative pain control at discharge. After 2 weeks, 34 patients (66.7%) rated QOL as high, 17 (33.3%) rated QOL as moderate, and none rated QOL as poor. Fascial suture was not associated with poor outcomes. Anxiety, depression, alcohol use, and prior abdominal surgery were not associated with increased need for post-operative narcotics. There were no significant differences between appendectomy and cholecystectomy in satisfaction with pain control or QOL ( p > 0.05). Conclusion Patients undergoing surgery have an increased risk of developing an opioid disorder. The NOpioid Project demonstrated a non-narcotic multimodal pain regimen can be effectively adopted in the post-operative period after an emergent laparoscopic appendectomy or emergent laparoscopic cholecystectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The NOpioid Project: a prospective observational feasibility study examining the implementation of a non-narcotic post-operative pain control regimen

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Indeed, most first-time opioid abusers receive medication from a friend or relative with leftover medication, highlighting the importance of education for safe and proper disposal of unused narcotics. 10 , 11 , 21 The comment from a patient about the plan to keep pain medications in case they are needed in the future is a pivotal example of the need for continued re-education and safe handling of medications.…”

Section: Discussionmentioning

confidence: 99%

“… 9 However, interventions to reduce opioid diversion through patient education have a positive effect. 10 , 11 Institution-based Enhanced Recovery After Surgery (ERAS) opioid-prescribing recommendations also result in reduced opioid overprescribing. 12 However, adherence to ERAS protocols for opioid prescribing remains suboptimal.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

Frost

Kohn

Wang

et al. 2022

JSLS

View full text Add to dashboard Cite

Background and Objectives: To evaluate postoperative opioid use after benign minimally-invasive gynecologic surgery and assess the impact of a patient educational intervention regarding proper opioid use/disposal. Methods: Educational pamphlets were provided preoperatively. Patients underwent hysterectomy, myomectomy, or other laparoscopic procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for hysterectomy/myomectomy, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents were maintained for alternatives). Pill diaries were reviewed and patient surveys completed during postoperative visits. Results: Of 106 consented patients, 65 (61%) completed their pill diaries. Median opioid use was 35 OME for hysterectomy (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for myomectomy (∼4 tablets; IQR 15-75), and 18.75 OME for laparoscopy (∼3 tablets; IQR 7.5-48.75). Median last post-operative day (d) of use was 3d for hysterectomy (IQR 2, 8), 4d for myomectomy (IQR 1, 7), and 2d for laparoscopy (IQR 0.5-3.5). One patient (myomectomy) required a refill of 5mg oxycodone. No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (>4 on a 5-point Likert scale) was 91% for hysterectomy, 100% for myomectomy, 83% for laparoscopy. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness. Conclusion: Most patients required <10 oxycodone 5mg tablets, regardless of procedure with excellent patient satisfaction. A patient education pamphlet is a simple method to increase knowledge regarding the opioid epidemic and facilitate proper medication disposal.

show abstract

“…In total, 11 RCTs fulfilled the inclusion criteria, which comprised 1604 patients (804 received opioid education, while 800 received standard care). [10][11][12][13][14][17][18][19][20][21][22] Seven trials were conducted in orthopedic surgery, 2 in breast surgery, 1 in urogynecology, and 1 in obstetrical surgery (cesarean section). Five trials followed patients until 15 days after surgery, 6 trials reported information for 6 weeks after surgery, and 3 followed patients until 3 months (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Zorrilla-Vaca

Mena²,

Ramírez

et al. 2021

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Opioids are the most commonly prescribed analgesics in the United States. Current guidelines have proposed education initiatives to reduce the risk of chronic opioid consumption, yet there is lack of efficacy data on such interventions. Our study evaluates the impact of perioperative opioid education on postoperative opioid consumption patterns including opioid cessation, number of pills consumed, and opioid prescription refills. METHODS: The MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and Google Scholar databases were systematically searched for randomized controlled trials (RCTs) assessing the impact of perioperative educational interventions (using either paper- or video-based instruments regarding pain management and drug-induced side effects) on postoperative opioid patterns compared to standard preoperative care among patients undergoing elective surgery. Our end points were opioid consumption (number of pills used), appropriate disposal of unused opioids, opioid cessation (defined as no use of opioids), and opioid refills within 15 days, 6 weeks, and 3 months. RESULTS: In total, 11 RCTs fulfilled the inclusion criteria, totaling 1604 patients (804 received opioid education, while 800 received standard care). Six trials followed patients for 15 days after surgery, and 5 trials followed patients up to 3 months. After 15 days, the opioid education group consumed a lower number of opioid pills than those in the control group (weighted mean difference [WMD], −3.39 pills; 95% confidence interval [CI], −6.40 to −0.37; P =.03; I2 = 69%) with no significant difference in overall opioid cessation (odds ratio [OR], 0.25; 95% CI, 0.04–1.56; P = .14; I2 = 83%). Likewise, perioperative opioid education did not have significant effects on opioid cessation at 6 weeks (OR, 0.69; 95% CI, 0.45–1.05; P = .10; I2 = 0%) and 3 months (OR, 0.59; 95% CI,0.17–2.01; P = .10; I2 = 0%) after surgery, neither reduced the need for opioid refills at 15 days (OR, 0.57; 95% CI, 0.28–1.15; P = .12; I2 = 20%) and 6 weeks (OR, 1.08; 95% CI, 0.59–1.98; P = .80; I2 = 37%). There was no statistically significant difference in the rate of appropriate disposal of unused opioids between both groups (OR, 1.99; 95% CI, 0.66–6.00; P = .22; I2 = 71%). Subgroup analysis by type of educational intervention showed a statistical reduction of opioid consumption at 15 days when implementing multimedia/audiovisual strategies (4 trials: WMD, −4.05 pills; 95% CI, −6.59 to −1.50; P = .002; I2 = 45%), but there was no apparent decrease when using only paper-based strategies (2 trials: WMD, −2.31 pills; 95% CI, −12.21 to 7.59; P = .65; I2 = 80%). CONCLUSIONS: Perioperative educational interventions reduced the number of opioid pills consumed at 15 days but did not demonstrate a significant effect on opioid cessation or opioid refills at 15 days, 6 weeks, and 3 months. Further randomized trials should focus on evidence-based educational interventions with strict homogeneity of material to draw a more definitive recommendation.

show abstract

A Randomized Controlled Trial Assessing the Impact of Opioid-Specific Patient Counseling on Opioid Consumption and Disposal After Reconstructive Pelvic Surgery

Cited by 12 publications

References 19 publications

The NOpioid Project: a prospective observational feasibility study examining the implementation of a non-narcotic post-operative pain control regimen

The NOpioid Project: a prospective observational feasibility study examining the implementation of a non-narcotic post-operative pain control regimen

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About