Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative

Abstract

IntroductionWe aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge.MethodsWe performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012–2014 (pre-implementation phase); 2014–2015 (implementation phase); and 2015–2017 (post-implementation).ResultsA total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively.ConclusionImplementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians’ reliance on administering and prescribing opioids.

Trends in Acute Pain Management for Renal Colic in the Emergency Department at a Tertiary Care Academic Medical Center

“…Motov and colleagues evaluated the prescribing patterns of physicians treating renal colic following the implementation of an opioid reduction initiative at their institution. 17 The authors observed a 12.7% overall reduction in opioid administration during the ED encounter and a 25.5% reduction in opioid prescribing at discharge. This equated 432 fewer patients receiving opioids while in the ED and 768 fewer patients leaving with an ED prescription.…”

Opioid Prescription Patterns for Discharged Patients from the Emergency Department

“…Identifying which diagnosis is associated with higher frequency of opioid prescriptions can be crucial to implementing symptom specific guidelines for opioid prescriptions in an effort to curtail the use of opioids in the ED and upon discharge. A previous study demonstrated a reduction of opioid administration for renal colic after implementation of a opioid-reduction initiative based on pain syndrome-targeted opioid alternative protocols [ 21 ]. Similarly, a number of recent studies have demonstrated a reduction in opioid prescriptions after the implementation of opioid prescribing guidelines for emergency physicians [ 22 , 23 ].…”

Opioid Reflex at Triage Is Not a Solution for Opioid-Naive Patients in Emergency Departments

“…Opioid sparing is already recommended in several acute pain pathologies, such as renal colic or low back pain. 5 Likewise, we should focus on ED organization to protect opioid-naive patients from a high risk of opioid misuse.…”