Implementing an opioid reduction protocol in renal transplant recipients.

Area of Science:

• Nephrology
• Transplant Surgery
• Pain Management

Background:

• Post-operative opioid dependence affects 6% of opioid-naïve patients.
• A protocol was implemented in renal transplant recipients to eliminate opioid patient-controlled analgesia (PCA) and utilize a multi-modal non-opioid regimen.

Purpose of the Study:

• To examine the impact of PCA elimination on opioid requirements at discharge in renal transplant recipients.

Main Methods:

• Adult renal transplant recipients were reviewed pre- and post-protocol implementation.
• Patients with intra-abdominal or pancreas-renal transplants, or chronic pain, were excluded.
• Discharge opioid prescriptions were evaluated against inpatient opioid use and recent recommendations.

Main Results:

• PCA use decreased significantly from 81% to 4.2% post-intervention (p < 0.001).
• Use of gabapentin, topical lidocaine, and acetaminophen increased significantly post-intervention.
• PCA use did not impact the median discharge opioid prescription (75 OMEs); excess opioid prescriptions at discharge remained prevalent.

Conclusions:

• A multidisciplinary approach successfully reduced PCA use and increased non-opioid adjuncts in renal transplant recipients.
• Despite protocol changes, patients were frequently prescribed excess opioids at discharge.
• Continued provider communication and protocolization are crucial for optimizing post-operative pain management.