dures at their institution: laparoscopic cholecystectomy, laparoscopic
inguinal hernia repair, thyroidectomy/parathyroidectomy, robotic prosta-
tectomy, endoscopic sinus operations and laparoscopic sleeve gastrecto-
my. More than half of the patients used no opioids after their operations,
and almost all of the patients reported their pain was manageable,
according to the findings (osmag.net/bh4YSN).
The research team's work is motivated by the fact that many peo-
ple not taking opioids before their operations ("opioid-naïve")
become new chronic opioid users after their operations, says
Michael Englesbe, MD, FACS, the study's corresponding author and
a professor of surgery at the University of Michigan in Ann Arbor.
"We think a fundamental root cause of the opioid epidemic is opi-
oid-naïve patients getting exposed to opioids and then really strug-
gling to stop taking them post-operatively, and then moving on to
chronic opioid use, abuse, addiction and overdose," says Dr.
Englesbe.
The researchers enrolled 190 opioid-naïve patients. Participants
received specific instructions regarding post-op pain control, pain
expectations and counseling to learn to manage pain without opi-
oids. At their pre-op clinic visits, patients were instructed to take
acetaminophen or ibuprofen every 6 hours around the clock, and to
stagger these medications every 3 hours for maximum continuous
pain control.
After their surgeries, patients received prescriptions for 650 mg of
acetaminophen and 600 mg of ibuprofen, as well as a small "rescue"
prescription of opioids — mostly oxycodone — for uncontrolled
breakthrough pain. For example, laparoscopic cholecystectomy
patients were prescribed 4 oxycodone pills. Patients were instructed
that they didn't have to use the opioids if they didn't feel they were
needed.
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