Non-opioid Protocol May Reduce Opioid Prescription After Urologic Cancer Surgery - European Medical Journal

Non-opioid Protocol May Reduce Opioid Prescription After Urologic Cancer Surgery

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NON-OPIOID (NOPIOIDS) pain control measures and patient education can help eliminate the need to prescribe opioid treatments post-discharge after major urologic cancer surgery, according to new data. Benjamin Davies, Chief of Urology at the University of Pittsburgh Medical Center Shadyside, Pennsylvania, USA, who was not involved in the study, stated: The vast majority of patients undergoing all forms of urologic cancer surgery do not need post-operative opioids, a fact shown several times before both in formal randomised controlled trials and more interventional-based protocols like this one.” 

Badar Mian, Albany Medical College, New York, USA, and colleagues conducted a study among 650 opioid-naïve patients who had undergone either open or minimally invasive cancer surgery at a tertiary care referral centre, including radical or partial nephrectomy, radical prostatectomy, and radical cystectomy with urinary diversion. The patients were divided into a NOPIOIDS protocol group, a lead-in group, and a control group. The team found that for those who received an instruction sheet explaining why opioids should be avoided and replaced by non-opioid medications for post-operative pain control, the rate of opioid prescriptions at discharge was 57.9%, with the median number of tablets prescribed being four, compared to 2.2% and zero tablets in those following the NOPIOIDS protocol, and 80.9% with 14 tablets for patients of the control group. The median and mean opioid dose for the NOPIOIDS group was of zero tablets in all procedures except for kidney procedures, with a mean of 0.5 tablets.  

Furthermore, pain scores in the NOPIOIDS group were a mean of 2.5 on a scale of one to 10, with patient satisfaction at a mean of 86.6 on a scale of one to 100. Thirty-day complication rates were similar in all groups. The researchers also noted that while there were more telephone calls to the office for any reason after discharge in the NOPIOIDS group (41 compared to 34 in the control group), the number of calls related to inadequate pain control was similar in all groups.  

The team concluded that this peri-operative protocol “may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.” A study limitation included systemic factors, including state-mandated education, dose limits, as well as general awareness about opioids, which could have influenced prescribing behaviour.  

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