Choosing Wisely:

Avoid opioid-only modalities for postoperative pain control.

Rationale and Comments: Opioid overdose has become one of the leading causes of injury related death in the United States and can be linked to the rising rates of opioid prescriptions. Many patients report unused opioid prescriptions following surgery, and there is a growing call for better standardization of opioid prescribing practices. Surgeons should utilize additional strategies such as locoregional anesthetic blocks and nonopioid medications (acetaminophen, NSAIDS, and gabapentoids) for pain management where possible.
Sponsoring Organizations:
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Sources:
  • Systematic review
  • Disciplines:
  • Surgical
  • Neurologic
  • References: • Bicket, MC et al., 2017. Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA surgery, 152(11), pp.1066–1071.
    • Dart, RC, Severtson, SG, Bucher-Bartelson, B, 2015. Trends in opioid analgesic abuse and mortality in the United States. The New England Journal of Medicine, 372(16), pp.1573–1574.
    • Derry, CJ, Derry, S, Moore, RA, 2013. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane database of systematic reviews (Online), (6), p.CD010210.
    • Hill, MV et al., 2017. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. Journal of the American College of Surgeons.

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