Opioid Use After Inguinal and Ventral Hernia Repair

Abstract

Background Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient-reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing. Methods All patients who underwent primary ventral (umbilical and epigastric), incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient-reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME). Results A total of 162 surgeries were performed during the study period, and 107 had patient-reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME. Conclusion Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid-free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than previously thought.

Opioid-Free Recovery After Hernia Repair with HTX-011 as the Foundation of a Non-Opioid, Multimodal Analgesia Regimen in a Real-World Setting: A Randomized, Open-Label Study

“…As such, opioids should only be prescribed when necessary and at the lowest possible effective dose [18]. Substantial progress has been made over the past 5 years regarding opioid-sparing postoperative protocols and decreased discharge [2,6,[18][19][20], with growing evidence that many patients may require at most only three pills [2,6,14,21,22]. In addition, limits on duration and/or doses of opioids have been enacted by state programs, large payers, and pharmacy chains and benefit managers [23].…”

“…Substantial progress has been made over the past 5 years regarding opioid-sparing postoperative protocols and decreased discharge prescription opioid quantities. Current literature recommends a discharge prescription range of 0 to 15 oxycodone (5 mg) pills for inguinal herniorrhaphy [ 2 , 6 , 18 – 20 ], with growing evidence that many patients may require at most only three pills [ 2 , 6 , 14 , 21 , 22 ]. In addition, limits on duration and/or doses of opioids have been enacted by state programs, large payers, and pharmacy chains and benefit managers [ 23 ].…”

“…In addition, the initial results of opioid duration and/or dose limits by states and organizations have indicated that these programs have not resulted in decreased opioid prescribing for acute pain [ 23 ]. Procedure-specific opioid prescribing recommendations and identification of risk factors for increased opioid consumption could help to avoid opioid overprescribing; however, additional guidance is needed for the individual patient [ 14 , 19 ].…”

“…The use of scheduled non-opioid MMA alone for inguinal hernia repair (open and laparoscopic), based on current literature, results in approximately 15–64% of patients recovering opioid-free [ 2 , 3 , 6 , 12 , 14 , 22 ]. Though the primary objective of the current study was not to assess the impact of HTX-011 on the rate of opioid-free patients, the use of HTX-011 in combination with scheduled non-opioid MMA resulted in 95% of patients overall with an opioid-free recovery through the 15-day follow-up period.…”

“…This study, Helping Opioid Prescription Elimination Hernia-1 (HOPE Hernia-1), is part of the HOPE project, which is designed to provide surgeons with practical real-world solutions to effectively manage postoperative pain and eliminate the need for opioid prescriptions using an HTX-011-based non-opioid MMA regimen. Oral ibuprofen and acetaminophen are commonly used after surgery [11][12][13][14][15]; however, there are limited data regarding the optimal schedule for their concomitant use. This study was designed to identify which of two postoperative MMA regimens-concurrent or alternating ibuprofen/acetaminophen-following intraoperative administration of HTX-011 in patients undergoing open inguinal herniorrhaphy, with prospective verification of an opioid prescribing algorithm, would result in a higher proportion of patients not requiring a prescription for postoperative opioids in a realworld setting.…”