Optimization of postoperative opioid prescriptions in gynecologic oncology: Striking a balance between opioid reduction and pain control

Implementation of a validated post-operative opioid nomogram into clinical gynecologic surgery practice: A quality improvement initiative

“…Specifically, more than 45% of patients did not use a single opioid pill following surgery in this study. This is consistent with previous literature reporting 20.4–47.3% of opioids prescribed following a variety of gynecologic surgeries are not utilized ( Straubhar et al, 2021 , Nwosu et al, 2022 , McEntee et al, 2021 ). Opportunities to identify patients unlikely to need any opioids for post-operative pain management would allow for further reduction of unnecessary opioid prescribing practices.…”

Enhanced Recovery after Surgery (ERAS) for Minimally Invasive Gynecologic Oncology Surgery: A Review

“…Within a post-surgical context, there needs to be an adequate balance between pain control and over-prescribing. In a retrospective study of both open and MIS gynecologic oncology postoperative patients, it was found that 39% did not use opioids, and half of those who had a laparotomy used less than two opioid pills after discharge [26]. Interestingly, this study also demonstrated that opioid use was not impacted by open or MIS surgery [26].…”

“…In a retrospective study of both open and MIS gynecologic oncology postoperative patients, it was found that 39% did not use opioids, and half of those who had a laparotomy used less than two opioid pills after discharge [26]. Interestingly, this study also demonstrated that opioid use was not impacted by open or MIS surgery [26]. A tiered opioid prescribing protocol in gynecologic oncology has been described, whereby differing prescription guidelines for differing surgical procedures and pain history are employed.…”

Evidence-based prescribing of opioids after laparotomy: A quality-improvement initiative in gynecologic oncology

“…This has evolved from uniform prescribing recommendations for an amount of opioids based on the surgical procedure done, to prescribing opioids based on inpatient hospital use of pain medications, to calculators like our own which utilize multiple patient factors to more precisely predict a patient’s need for opioids at home ( Boitano et al, 2020 , Glaser et al, 2020 , Michigan Opioid Prescribing Engagement Network, 2020 , Overton et al, 2018 , Rodriguez et al, 2022 , Straubhar et al, 2021 , Straubhar et al, 2023 ). Similarly developed calculators have been published by groups from Duke University and the University of Michigan ( Rodriguez et al, 2022 , Straubhar et al, 2021 , Straubhar et al, 2023 ). Their approaches combine minimally invasive and open surgical patients while we chose to focus on open surgical patients alone as our practice is to give no more than 5 doses of opioids after laparoscopic surgery.…”