A lower surgical opioid dose results in less long-term use, according to a study by Kaiser Permanente

A lower surgical opioid dose results in less long-term use, according to a study by Kaiser Permanente

Oakland, California. - Surgical patients who received fewer opioids and alternative methods of controlling pain were less likely to continue using opioids 6 months to a year later, according to an analysis by researchers at Kaiser Permanente Northern California.

The research letter, published in the Annals of Surgery on 20 June, compared and found a significant difference in the long-term use of opioids between groups of surgical patients before and after the introduction of the Enhanced Postoperative Surgery (ERAS) program. The ERAS program is used in all Kaiser Permanente 21 Northern California hospitals and offers improved pain control (including reduced opioid doses), preoperative nutrition, a focus on patient movement shortly after surgery, and better patient involvement in their recovery.

Vincent Liu, MD, MS, lead author of the Annals of Surgery study

"A standardized and targeted approach to pain management in the ERAS program can have long-term benefits," said MD Vincent Liu, chief medical officer, lead author, and Kaiser Permanente, a researcher in Northern California.

A 2017 study by Kaiser Permanente researchers published in the journal JAMA Surgery found that the program was associated with shorter hospital stays and fewer complications.

Liu and colleagues studied the data to determine how these surgical patients used opioids 6 months to a year later. Patients who have received opioids during surgery may be at increased risk of developing opioid use disorders.

They compared the groups of patients who received pre-ERAS surgery with those who were treated after the start of ERAS and found a dramatic difference: long-term opioid use was over 30% before ERAS implementation and less than 10% a year later.

The main exception to the improvement was found in patients who had already taken opioids before surgery. In these cases, patients were much more likely to continue long-term use after 6 months or a year.

"Patients with opioids before surgery remain a goal and an opportunity to understand how we can improve their recovery," said Dr. Liu.

According to research, ERAS methods can have long-term benefits, said senior Author Stephen M. Parodi, MD, CEO of Permanente Medical Group.

"We know that careful attention to the well-being of surgical patients can improve their recovery and facilitate faster hospital discharge," said Dr. Parodi. & nbsp; "This study suggests additional benefits of ERAS in reducing the long-term use of analgesics in patients not receiving preoperative opioids and consequently reducing the risk of developing postoperative opioid use disorders."

The study compared patients with hip and colorectal surgery who were part of the ERAS control group, abdominal surgery and orthopedic surgery, who did not follow the protocol but received standard hospital treatment. Interestingly, this group also experienced a similar rate of reduction with long-term opioid use.

"We think this finding could mean a 'halo effect', where ERAS principles were naturally transferred to other types of surgery," said Derrick Lee, anesthesiologist and Kaiser Permanente, ERAS clinical manager for Northern California. "The ERAS program also raised awareness of the risks of opioid treatment and helped introduce a sustainable opioid pain reduction strategy known as multimodal analgesia."

Dr. Liu noted some limitations of the study: it did not look at other factors in the patient's postoperative year, such as additional surgeries or uncontrollable pain. He also said the results may have been influenced by doctors' national efforts to reduce opioid prescribing over the past several years.

The studies were funded by The Permanente Medical Group and the National Institute of General Medical Sciences. Co-authors were Andy L. Avins, MD, MPH, Vivian Reyes, MD, Abigail Eaton, PhD, and Cynthia I. Campbell, PhD, MPH, Kaiser Permanente from the Research Department; and Shirley S. Paulson, DNP, Northern California, Kaiser Permanente.

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