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

Abstract

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.

Postoperative Pain: To a Better Management

“…A recent study evaluated the impact of perioperative opioid education on postoperative opioid consumption patterns including opioid cessation, number of pills consumed, and opioid prescription refills. 11 A total of 11 RCTs fulfilled the inclusion criteria, with a total of 1604 patients, of which 804 received opioid education, whereas 800 received standard care.…”

Multimodal Analgesia

“…14 Further, Waljee et al 4 note that proper education of patients in the perioperative period may lead to decreased incidence of misuse, as chronic opioid use after surgical intervention has been associated with greater preoperative global body pain and chronic pain conditions unrelated to the surgical region. 15 However, a systematic review and metaanalysis conducted by Zorrilla-Vaca et al 16 revealed lack of significant efficacy of perioperative patient educational materials in the reduction in opioid refills or complete opioid cessation at later time points within each of the 11 reviewed randomized controlled trials (RCTs). In contrast, use of procedure-specific guidelines regarding opioid medication prescribing strategies for surgeons has shown substantive benefit in the reduction of opioid prescription amounts.…”

How Patients Dispose of Unused Prescription Opioids: A Survey of over 300 Postoperative Patients

“…One individual randomized trial suggested there may be a benefit to additional perioperative education; however, education resulted in only modest increases in postoperative opioid disposal [12]. Moreover, when randomized control trials were considered together, a meta-analysis demonstrated a reduction in overall opioid consumption but with no significant difference in drug disposal when perioperative education was employed [13]. The results point to the potential for an unintended increase in unused opioids available for diversion when opioid consumption is mitigated without a concomitant reduction in disposal.…”