Majority of cancer surgery patients discharged without opioids with new pain management protocol, study finds

A Philadelphia-based hospital implemented a specialized pain management program for patients who underwent robotic surgery for urologic cancers, which resulted in a majority of patients being discharged home without opioids.

The Perelman School of Medicine at the University of Pennsylvania in Philadelphia implemented the program in September 2018. They detailed their findings at the 2019 American Society of Clinical Oncology Annual Meeting in Chicago, May 31 to June 4.

Researchers examined the effect of the program on patients undergoing robotic urological procedures, including radical prostatectomy, radical nephrectomy and partial nephrectomy. Previously, guidelines recommended sending these patients home with 15 to 45 oxycodone pills.

The program changed the pain management protocol so medications for robotic urological cancer surgery patients were escalated on an as-needed basis. Patients received gabapentin and acetaminophen before surgery. They received the drugs every eight hours after surgery, along with an IV dose of ketorolac. If patients still reported pain, they were given tramadol. Only if they continued to report pain were they given oxycodone pills, but they were limited to 10 pills.

Between September 2018 and January 2019, 115 of the 170 patients (68 percent) in the program were discharged without prescriptions for opioids, and another 41 (24 percent) went home with 10 pills of tramadol, which is not an opioid. "This means patients whose pain can be managed without opioids never end up getting them in the first place, while patients whose pain warrants these prescriptions receive them when needed," said study lead author Ruchika Talwar, MD, a resident in urology at Perelman School of Medicine

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