Preemptive Pain Management Reduces Opioid Use After Minimally Invasive Surgery

A preemptive pain management program involving OTC medications can help reduce opioid prescribing after surgery, according to a new study published in The Journal of Thoracic and Cardiovascular Surgery.

The findings indicated that the use of long-acting local anesthetics at the site of surgery and scheduled non-narcotic medications can mitigate opioid use after minimally invasive esophageal and gastrointestinal (GI) procedures. Fewer narcotic prescriptions proactively decreases the chances of patients becoming addicted to opioids.  

For the study, the researchers compared outcomes among patients who were managed with standard care (control group), enhanced recovery after surgery alone, or a preemptive pain management program with enhanced recovery after surgery. Over a 6-year period, more than 400 patients who underwent procedures such as hiatal hernia repair, reflux surgery, and achalasia surgery at Houston Methodist Hospital were evaluated.

In the enhanced recovery after surgery with preemptive pain management group, patients and surgeons discussed enhanced patient education about use of scheduled OTC medication preemptively. Patients also received long-acting local anesthetics and maintained scheduled doses of non-narcotic pain medication, such as Tylenol, at the hospital and home following surgery. 

Overall, among all of the patients in the study, those in the preemptive pain management group had the fewest opioid prescriptions at discharge (9.6%) and fewer postoperative complication (3.2%), according to the study. The control group had the most postoperative complications (15.1%) and 87% were discharged with opioid prescriptions.

The study authors concluded that the preemptive pain management program was associated with opioid-free discharge after minimally invasive foregut surgery.

“This study provides a strategy to reduce opioid prescriptions after foregut surgery and, if implemented nationally, could decrease the amount of opioid used in the community,” they wrote.

References:

• Kim MP, Godoy C, Nguyen DT, et al. Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery. The Journal of Thoracic and Cardiovascular Surgery. 2020. Doi: https://doi.org/10.1016/j.jtcvs.2019.06.056