The Standardization Of Outpatient Procedure (STOP) Narcotics: A Prospective Non-Inferiority Study To Reduce Opioid Use In Outpatient General Surgical Procedures
Abstract
Surgeons play a significant role in the opioid crisis. A standardized, multipronged analgesia protocol was implemented with the objective of providing adequate analgesia while reducing opioids after outpatient breast and anorectal surgery.
A prospective, pre- and post-intervention study was designed to demonstrate non-inferiority for patient-reported post-operative pain. The intervention included patient and provider education, and multimodal perioperative analgesic strategies including opioid rescue prescriptions.
We evaluated 266 procedures. After implementation of the STOP Narcotics protocol, average post-operative pain scores in the post-intervention groups was non-inferior compared to the pre-intervention groups [(2.0 vs 2.1/10, p = 0.40, breast procedures) and (2.8 vs 2.6/10, p = 0.33, anorectal procedures)]. Opioid prescribing decreased by 50%. Only 45% of patients filled their rescue opioid prescriptions.
A standardized pain care bundle significantly decreased opioid prescribing while adequately treating post-operative pain. This initiative provides a framework for future guidelines in outpatient breast and anorectal surgery.