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  • Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations

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Original research
Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations
  1. Gina Votta-Velis1,2,
  2. Martha L Daviglus3,
  3. Alain Borgeat2,
  4. Katharina Beckmann1,
  5. Andrew Q Ta1,
  6. John L Parker4,
  7. Sasha Kravets5,
  8. Olga L Garcia3,
  9. Amber Pirzada3,
  10. Nicole Gastala6,
  11. Valentina Valle2,
  12. Jamie J Benken7,
  13. Maya Campara7,
  14. Gabriela Aguiluz2,
  15. Stavros G Memtsoudis8,
  16. Pier C Giulianotti2 and
  17. Enrico Benedetti2
  1. 1 Anesthesiology, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
  2. 2 Surgery, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
  3. 3 Institute for Minority Health Research, Department of Medicine, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
  4. 4 Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
  5. 5 Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, Illinois, USA
  6. 6 Family Medicine, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
  7. 7 Pharmacy Practice & Surgery, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
  8. 8 Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
  1. Correspondence to Dr Gina Votta-Velis, Anesthesiology and Surgery, University of Illinois Chicago College of Medicine, Chicago, IL 60612, USA; ginavot{at}gmail.com

Abstract

Introduction This study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.

Methods This prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.

Results Postoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: −0.58, 0.10; non-inferiority margin=−1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15) vs 8.17 morphine milliequivalents (MMEs) (IQR=40.33); p<0.01) and had fewer discharge prescription opioids (median=0 (IQR=60) vs 86.4 MMEs (IQR=140.4); p<0.01).

Discussion The SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids.

  • postoperative pain
  • pain management
  • clinical pain
  • analgesics, opioid
  • acute pain

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2022-103864

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @mayacampara, @sgmemtsoudis

    • Contributors EV-V—guarantor, conception and design, analysis, and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval. EB, MLD and AB—conception and design, analysis, and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval. AQT, JLP, VV and GA—acquisition, analysis, and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval. OLG, AP and NG—analysis of data, revising the article critically for important intellectual content and final approval. SK—statistical analysis, interpretation of data, revising the article critically for important intellectual content and final approval. JJB, MC and KB—conception and design, analysis, and interpretation of data; revising the article critically for important intellectual content; and final approval. PCG and SGM—conception and design, and interpretation of data; revising the article critically for important intellectual content; and final approval. As a guarantor, EV-V accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors had departmental funding for this manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.