Are opioids being over-prescribed in gynaecology surgery?
Although opioids are highly effective in managing post-operative pain, patients undergoing surgical procedures are at risk of developing a new persistent opioid. Concerns regarding the volume of patients on long-term opioids in our region prompted a service evaluation to review take-home post-operative opioid prescriptions in gynaecology surgical patients. Results showed an average duration of opioid prescription of 7.9 days and longer durations of take-home opioid prescriptions in the laparoscopy group compared to the laparotomy group (8.6 vs 7.1 days), despite lower inpatient opioid consumption in these groups (10.2 mg vs 17.0 mg morphine equivalent daily dose). Previous studies have quantified patients' post-operative opioid consumption and demonstrated effective use of restrictive opioid regimes. The unit described is prescribing more than has been demonstrated to be consumed and therefore required. As the duration of opioid use is recognised as the strongest predictor of future opioid misuse, an opioid duration limit of 3 days is suggested.
Adequate analgesia is vital in the recovery of gynaecological surgical patients. Pain is commonly experienced by patients following gynaecological surgery and even minimally invasive techniques, such as laparoscopy, may lead to postoperative pain in up to 35–80% of patients (van Dijk et al, 2018). Moderate or severe post-operative pain can negatively influence factors such as mobilisation, length of hospital stay and time taken to return to usual activities of daily living (Garimella and Cellini, 2013). Uncontrolled acute pain may also lead to chronic pain. Minimally invasive gynaecological surgical techniques, such as laparoscopic hysterectomy and myomectomy, have contributed to a reduction in the duration of inpatient stay and patient recovery times (Johnson et al, 2005; Barakat et al, 2011). However, analgesia is still required for patient recovery and these requirements extend from the inpatient stay to an undefined period of time post-discharge.
Register now to continue reading
Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:
Limited access to our clinical or professional articles
New content and clinical newsletter updates each month