By Pat Anson, PNN Editor

Another hospital is touting the benefits of not giving opioid analgesics to patients after minimally invasive surgeries.

Surgeons at Houston Methodist Hospital say they were able to significantly reduce opioid prescriptions given to patients recovering from hernia repair, reflux surgery and other minimally invasive GI-related procedures by treating them with acetaminophen (Tylenol) for post-operative pain.

In a study involving over 400 surgery patients reported in the Journal of Thoracic and Cardiovascular Surgery, Houston Methodist surgeons compared patients treated with acetaminophen to a control group of patients given opioids.

Patients who were treated with acetaminophen had fewer post-operative complications (3%) than those given hydrocodone or tramadol (15%).  They were also significantly less likely to be discharged from the hospital with an opioid prescription than patients in the control group (10% vs. 87%).  

"Just a decade ago we routinely prescribed narcotics to treat pain at home after surgery," said lead author Min Kim, MD, head of the division of thoracic surgery at Houston Methodist Hospital. "We wanted to determine if we could manage pain at home after surgery with over-the-counter pain medication. We developed and implemented the pre-emptive pain control program, which led to excellent pain control at home without requiring prescription narcotics."

Patients in the pre-emptive pain management group received long-acting local anesthetics at each incision. They were also given scheduled doses of acetaminophen or naproxen in the hospital and at home.

"This study provides us with a strategy to successfully manage pain after surgery using over-the-counter pain medication. This led to fewer narcotic prescriptions which proactively decreases the chance of patients becoming addicted to narcotics," Kim said.

Opioid Addiction Rare After Surgery

Few patients actually become addicted after surgery. A 2016 Canadian study, for example, found that long term opioid use after surgery is rare, with less than one percent of older adults still taking opioids a year after major elective surgery.

Another large study in the British Medical Journal found only 0.2% of patients who were prescribed opioids for post-surgical pain were later diagnosed with opioid dependence, abuse or experienced a non-fatal overdose.

Nevertheless, many hospitals have reduced their use of opioids or stopped giving them to patients altogether.

A statewide effort in Michigan reduced the number of opioid pills given to patients after common operations from an average of 26 pills per patient to 18. The surgeries included minor hernia repair, appendix and gallbladder removal, and hysterectomies. Most were minimally invasive laparoscopic surgeries.

In Ohio, patients at Akron General Hospital are getting acetaminophen, gabapentin and non-steroidal anti-inflammatory drugs (NSAIDs) to manage their pain after elective colorectal operations. Surgeons say over 75 percent of them are sent home without an opioid prescription.

And in Vermont, a 2017 state law requires doctors to use non-opioid pain relievers as first-line treatments for post-operative plan. If they are prescribed opioids, patients are initially limited to no more than 10 pills.

Houston Methodist Hospital is expanding its pre-emptive pain management program to include patients recovering from pulmonary surgery.