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Prescribing Recommendations | Adult Opioid Prescribing Recommendations

Obstetrics and Gynecology

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Oxycodone
5mg
Hysterectomy – Vaginal or Laparoscopic/Robotic or Abdominal
0-10

DATA ANALYSIS

Laparoscopic Hysterectomy

  • Patient Reported Outcomes data collected via Michigan Surgical Quality Collaborative
  • January 1, 2018 – October 31, 2021
  • 3651 Opioid Naive Patients from 56 Michigan Hospitals

Vaginal Hysterectomy

  • Patient Reported Outcomes data collected via Michigan Surgical Quality Collaborative
  • January 1, 2018 – October 31, 2021
  • 1624 Opioid Naive Patients from 60 Michigan Hospitals

Abdominal Hysterectomy

  • Patient Reported Outcomes data collected via Michigan Surgical Quality Collaborative
  • January 1, 2018 – October 31, 2021
  • 1202 Opioid Naive Patients from 59 Michigan Hospitals

SUPPORTING LITERATURE

DeBlanc et al. 2022 (Level 3 evidence)

  • DOI: https://doi.org/10.1016/j.ajog.2021.12.114
  • Analyzed data from 2,359 individuals who underwent a hysterectomy at a single institution between 1 January 2018-31 October 2019.
  • Recommended prescription for abdominal hysterectomy = 7 tablets.
  • Recommended prescription for laparoscopic or vaginal hysterectomy = 5 tablets.
Cesarean Section
0-20

SUPPORTING LITERATURE

Bateman et al. 2022 (Level 3 evidence)

  • DOI: http://doi.org/10.1097/AOG.0000000000002093
  • Analyzed 720 women who had undergone a cesarean delivery at six academic medical centers in the United States from September 2014-March 2016.
  • Median number of dispensed opioid tablets = 40.
  • Median number of consumed opioid tablets = 20.
  • Median leftover opioid tablets = 15.
  • 85.4% filled an opioid prescription.

OPIOID PRESCRIBING

When an opioid is needed after surgery, use the OPEN prescribing recommendations as the foundation for a shared decision-making conversation with the patient to determine the best prescription size.

It’s important to note that these are not rigid rules that must be adhered to, but rather recommendations. Starting form a standardized approach and then allowing for individualization helps promote both equity and patient-centeredness.

  1. Determine the opioid prescribing range based on:
    • Type of procedure
    • Additional procedures performed
  2. With the patient, determine the best prescription size within the appropriate range
    • Assess for individual risk factors
    • Consider patient preferences and other non-opioid strategies utilized
    • Pain management at the time of discharge:
      • Pain scores in 24 hours prior to discharge
      • Medication use in 24 hours prior to discharge
      • Timing of discharge