Examining Reduced Opioid Prescriptions after Gynecologic Laparoscopy: A Randomized Controlled Trial

Abstract

To examine whether prescribing 5 tablets, as opposed to 10 tablets, of 5-mg oxycodone adequately treats pain after gynecologic laparoscopy. Design: Single-blinded randomized trial. Setting: Academically affiliated ambulatory surgery center. Patients: One hundred twenty women scheduled to undergo minor gynecologic laparoscopy. Interventions: Patients scheduled for ambulatory gynecologic laparoscopy were allocated to the standard tablet or low-tablet number prescription groups (10 tablets or 5 tablets of 5-mg oxycodone). The patients also received prescriptions for acetaminophen and ibuprofen. Measurements and Main Results: Telephone surveys were conducted on postoperative days 1 and 7 to assess medication use and pain. The primary outcome was the number of oxycodone tablets used by days 1 and 7. Prespecified secondary outcomes included unscheduled patient contacts and pain scores. With N = 50 in each group and assuming standardized effect sizes, the study was powered to detect a 0.6 difference or greater when comparing the primary outcome between the groups. Forty-five and 47 patients in the 5-tablet and 10-tablet groups, respectively, completed the day-7 survey. The median number of oxycodone tablets taken by day 7 was 2.0 (interquartile range 0.0, 4.0) in the 5-tablet group and 2.5 (interquartile range 0.0, 5.0) in the 10-tablet group (p = .36). Most of the patients in both groups reported taking 3 oxycodone tablets or fewer by day 7. There were no significant differences in unscheduled patient contacts, need for additional prescriptions, or pain scores. There were significantly fewer unused tablets in the 5-tablet group by day 7. Conclusion: Prescribing 5 tablets of 5-mg oxycodone, acetaminophen, and ibuprofen is likely sufficient for most patients after minor laparoscopic surgery.

Efficacy of Different Preemptive Analgesia on Postoperative Analgesia, Oxidative Stress, and Inflammatory Response after Gynecological Laparoscopic Surgery

“…is treatment is clinically called preemptive analgesia [15]. Oxycodone, as an opioid μ and κ double receptor agonist, took effect 2 min after intravenous injection and peaked at 5 min, lasting for about 3.5 h, without causing histamine release and bradycardia, or inhibiting the parasympathetic nerve, thus exerting a better inhibitory effect on visceral pain [16,17]. Although pentazocine is an opioid analgesic, its mechanism action is quite different from morphine.…”

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

“…Although many studies have looked at the impact of ERAS implementation on opioid use, duration of stay, and pain scores, few studies have examined whether a decrease in opioid prescriptions leads to an increased clinical burden in the form of phone calls or unscheduled visits. Some authors have shown no differences in post-operative phone calls or visits between patients who received 10 vs 5 tablets of oxycodone following minor gynecologic laparoscopy, however, the study population was small (100 patients) and the follow-up period was short (one week) [24]. Others have also shown no differences in post-operative pain and activity interference in a 42-day postoperative period following minimally invasive gynecologic surgery, despite an 83% reduction in opioids prescribed [25].…”

Trends in Opioid Prescriptions after Laparoscopic Sterilization

“…Even as the number of opioids prescribed between the groups and consequently more unused opioid pills in the latter. 17 These findings have important implications as a larger initial prescription incurs more risk for a long-term opioid use disorder. 8,18 Additional research investigating the appropriate number of postoperative opioid pills is needed, in particular identifying in which patients an opioid-free approach may be feasible.…”