How Low Can You Go: Achieving Post-Operative Outpatient Pain Control without Opioids.

Research paper by Vasiliy V Sim, Samuel S Hawkins, Asaf A AA Gave, Alex A Bulanov, Fady F Elabbasy, Leen L Khoury, Melissa M Panzo, Elizabeth E Sim, Stephen S Cohn

Indexed on: 13 Jun '19Published on: 03 Apr '19Published in: The journal of trauma and acute care surgery


Post-operative outpatient narcotic over-prescription plays a significant role in the opioid epidemic. Outpatient opioid prescription ranges from 150 - 350 oral morphine equivalent (OME) for a laparoscopic cholecystectomy or appendectomy, with 75 OME (10 pills of 5mg of oxycodone) being the lowest recommendation (1). We hypothesized that the addition of non-opioid medications to the outpatient pain control regimen would decrease the need for narcotics. In this prospective observational pilot study we prescribed a 3-day regimen of ibuprofen and acetaminophen to patients after uncomplicated laparoscopic cholecystectomies and appendectomies. An additional opioid prescription for five pills of 5mg oxycodone (37.5 OME) was written for breakthrough pain. During their post-operative visit we evaluated patients' adherence to the pain control regime, their post-discharge opioid use, and the adequacy of their pain control. 65 patients were included in the study, 52% male. The majority (80%) of surgeries were performed urgently or emergently. The VAS pain score at home was significantly better than upon discharge (3.7 vs 5.5, p=0.001). The average number of oxycodone pills taken post-discharge was 1.8 pills. Half of the patients (51%) did not take any opioids. All but four patients reported that their pain was adequately controlled. No patient required additional opioid prescriptions or visited the Emergency Department. This study demonstrated that opioids can be eliminated in at least half of the patients, and that five pills of 5mg oxycodone (37.5OME) is sufficient for outpatient pain control when a 3- day course of ibuprofen and acetaminophen is prescribed. III STUDY TYPE: therapeutic.