Standardization of Narcotic Prescriptions in Minimally Invasive General Surgery Procedures

The opioid crisis is a major public health issue, and postoperative opioids play a unique role. Many institutions have implemented standardized protocols to decrease excess opioids available. The objective of this study was to establish a standardized pain protocol for common surgical procedures and assess postoperative pain control.

This is a prospective observational study based on the Michigan Opioid Prescribing Engagement Network network guidelines which provides prescription recommendations for surgical procedures. We evaluated all laparoscopic/robotic cholecystectomy, appendectomy, and all herniorrhaphies. Patients were prescribed a predetermined number of narcotics by procedure as part of a multimodal pain regimen. A survey was conducted within 14 d postoperatively to assess pain control and narcotic utilization.

A total of 442 patients were included from July 1, 2022 to October 28, 2022. Survey response was 40% (178/442) with 56% (249/442) prescribed per protocol. Fewer patients prescribed per protocol required refills, 9.6% (24/249) compared to 18.1% (35/193) (P = 0.007) without protocol. Patients reported taking significantly fewer narcotics with the protocol versus without (median = 5.0 versus 10.0, P < 0.001). The median number of narcotics taken were 5.5 for appendectomy, 7.0 for cholecystectomy, and 9.0 for herniorrhaphy. There was no difference in pain control when comparing patients with and without protocol (91.1% versus 90.5%, P = 1.0).

This study demonstrated that postoperative opioid prescriptions can be decreased by implementing a standardized protocol incorporating a multimodal regimen while adequately controlling pain following surgery.