PRACTICE PARTNER
A
n Ontario study found that
physicians were able to reduce the
overall amount of opioids being
prescribed after general surgery by
50 per cent while still adequately treating a
patient’s post-operative pain.
“Significantly reducing the amount of
opioids prescribed, decreases the exposure risk
and potential for misuse of narcotic medica-
tion,” said Dr. Luke Hartford, a resident in
general surgery at Western’s Schulich School
of Medicine and Dentistry and first author on
the study. “This also decreases excess medica-
tion available to be diverted to individuals for
whom it was not intended.”
The study involved 416 patients at Lon-
don Health Sciences Centre (LHSC) and St.
Joseph’s Health Care London who underwent
laparoscopic cholecystectomy or open hernia
repair.
Roughly half the patients were randomly
assigned either to a control group, which
received a standard prescription for opioids,
or to the STOP Narcotics protocol group,
which were prescribed acetaminophen and
an anti-inflammatory drug to manage post-
surgical pain for the first 72 hours after their
operations.
The protocol instructed physicians to write
a limited prescription of ten pills of opioids
(Tramadol), with an expiry date of seven days
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DIALOGUE ISSUE 4, 2018
after surgery, with instructions for the patient
to fill this prescription only if adequate pain
control was not otherwise achieved. There
were also instructions on proper disposal of
unused medication for the patient.
“We recognized that before STOP Narcot-
ics, every surgeon had a different approach
to pain control, and that most surgeons were
prescribing more narcotics than are actually
needed,” said Dr. Ken Leslie, Chair/Chief of
the Division of General Surgery at London
Health Sciences Centre, who led the imple-
mentation of the new proposal. “When we
looked at the data from this new protocol, we
saw that the patient’s pain-control was just
as good with this pathway, without a huge
prescription for narcotics.”
The results showed that in the STOP
Narcotics group, compared to a control
group, there was a 50 per cent reduction
in the number of opioids being prescribed.
They also demonstrated that only 45 per
cent of patients actually filled their opioid
prescription, compared to 95 per cent in
the control group, and they were also able
to increase appropriate disposal of excess
opioid medication from 7 per cent in the
control group to 23 per cent in the STOP
Narcotics group. The levels of reported
post-operative pain were the same in both
groups.
MD
Post-op Pain
Controlled with
Significant Cut
in Opioids