Researchers at the University of Texas MD Anderson Cancer Center seeking to improve hospital care pathways, say that a newly designed recovery program reduced opioid use after pancreatic cancer surgery. The researchers noted in their study, published today in the journal JAMA Surgery, that this approach has the potential to reduce the risk of long-term opioid dependence in patients post-surgery.
The study involved 832 patients who were undergoing pancreatic resection surgery to understand how making incremental modifications to post-surgery care could affect the amounts of opioids used at discharge. Over the course of about four years, the total oral morphine equivalents (OMEs) delivered to patients recovering in the hospital were reduced from a median of 290 mg per patient, to 129 mg. Total OMEs prescribed at discharge decreased from a median of 150 mg to 0 mg, with more than 75% of patients discharged with less and 50 mg, or fewer than 10 pills.
“Patients not regularly taking opioids are at risk of developing a new dependence after surgery, and excess pills also create a risk of misuse by family members or others in their community,” said senior author Ching-Wei Tzeng, MD, associate professor of Surgical Oncology at MD Anderson. “Pancreatic cancer surgery can be a painful operation with a difficult recovery. This study shows that, even in this setting, easy-to-implement strategies can achieve effective pain control for our patients without putting them at risk for opioid dependence.”
Pancreatic surgery is complex, as it involves multiple abdominal organs simultaneously, which results in an “expected level” of post-surgical pain, the researchers noted. Medication is a key component of managing patient pain during this time, and the MD Anderson team sought to find ways to reduce opioid use by employing nerve blocking procedures and non-opioid medications such as muscle relaxers and anti-inflammatories, along with early patient mobilization. Successfully managing pain via these methods could lessen the risk of opioid misuse and addiction, one of the most pressing public health challenges.
In all, the study, which ran from 2018 to 2022, comprised of three consecutive cohorts each with iterative revisions to post-surgical pathways. The team first established a baseline for patients and reduced length of stay, then provided patient-provider educational materials, limited the use of intravenous opioids while suggesting a three-drug non-opioid pain management bundle. The researchers also implemented what they termed a “5x-multiplier” for patients at discharge—a prescribed amount equal to five times the OME given to the patients over the previous 24 hours.
Patients in the study cohorts reported pain scores of less than three on a scale of one to ten. There were no differences in post-discharge medication refill requests, with most patients not requiring a refill after discharge, and no differences among the three cohorts.