Dialogue Volume 14 Issue 4 2018 - Page 36

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 36 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