Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus

Area of Science:

• Pain Management
• Surgical Oncology
• Pharmacology

Background:

• Opioid overprescribing after surgery is a significant issue, leading to long-term use in 1 in 16 patients.
• Lack of standardized, procedure-specific guidelines contributes to wide variations in opioid prescribing practices.
• Multidisciplinary expert consensus is needed to establish ideal opioid prescribing protocols.

Purpose of the Study:

• To develop consensus-based, procedure-specific opioid prescribing guidelines for common surgical procedures.
• To address the variation and potential overprescribing of opioids in the post-surgical setting.
• To create patient-centered recommendations for opioid use after surgery.

Main Methods:

• A 3-step modified Delphi method was employed.
• A multidisciplinary expert panel (surgeons, pain specialists, nurse practitioners, residents, patients, pharmacists) was convened.
• Consensus ranges for outpatient opioid prescribing were developed for 20 common procedures in opioid-naïve adults.

Main Results:

• The panel recommended a minimum of 0 opioid tablets for all 20 procedures, with ibuprofen as a standard alternative.
• Maximum opioid tablet recommendations varied by procedure, with a median of 12.5 tablets.
• 15% of procedures had a maximum recommendation of 0 opioid tablets, while 30% allowed up to 20 tablets.

Conclusions:

• Procedure-specific prescribing guidelines can help curb opioid overprescribing by clinicians.
• Developing multidisciplinary, patient-centered consensus guidelines for more procedures is feasible.
• These guidelines can serve as a valuable tool in addressing the ongoing opioid crisis.