Acute Care Opioid Treatment and Prescribing Recommendations: Surgical Department

 

Surgical Department

Preoperative Counseling: For patients not using opioids before surgery

• Discuss the expectations regarding recovery and pain management goals with the patient.
• Educate the patient regarding safe opioid use, storage, and disposal.
• Determine the patient’s current medications (e.g., sleep aids, benzodiazepines), and any high-risk behaviors or diagnosis (e.g., substance use disorder, depression, or anxiety).
• Do NOT provide opioid prescription, for postoperative use, prior to surgery date.

Intraoperative

• Consider nerve block, local anesthetic catheter or an epidural when appropriate.
• Consider non-opioid medications when appropriate (e.g., ketorolac).

Postoperative

• Meperidine (Demerol) should NOT be used for outpatient surgeries.
• If opioids are deemed appropriate therapy, oral is preferred over IV route.
• Ensure all nursing, ancillary staff and written discharge instructions communicate consistent messaging regarding functional pain management goals.

For patients discharged from surgical department with an opioid prescription

• The prescription drug monitoring program (PDMP) must be accessed prior to prescribing controlled substances schedules 2-5, in compliance with Michigan law.
• Non-opioid therapies should be encouraged as a primary treatment for pain management (e.g., acetaminophen, ibuprofen).
• Non-pharmacologic therapies should be encouraged (e.g., ice, elevation, physical therapy).
• Do NOT prescribe opioids with other sedative medications (e.g., benzodiazepines).
• Short-acting opioids should be prescribed for no more than 3-5 day courses (e.g., hydrocodone, oxycodone).
• Fentanyl or Long-acting opioids such as methadone, OxyContin and should NOT be prescribed to opioid naïve patients.
• Consider offering a naloxone co-prescription to patients who may be at increased risk for overdose, including those with a history of overdose, a substance use disorder, those already prescribed benzodiazepines, and patients who are receiving higher doses of opioids (e.g., >50 MME/Day).
• Educate patient and parent/guardian (for minors) regarding safe use of opioids, potential side effects, overdose risks, and developing dependence or addiction.
• Educate patient on tapering of opioids as surgical pain resolves.
• Refer to opioidprescribing.info for free prescribing recommendations for many types of surgeries.