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Home E-Weekly October 3, 2017

Uncovered: The Holy Grail of Opioid Prescription Durations After Surgery

Published: October 2, 2017

JUST RIGHT? Prescriptions should generally last between 4 and 15 days, depending on the type of surgery.

Researchers say they're getting closer to pinpointing a Goldilocks range for opioid prescriptions after surgery — the volume of painkillers that's neither too generous nor too sparse. For patients having general surgery, scripts should cover 4 to 9 days, they say; for those having women's health procedures, 4 to 13 days is appropriate; and for those undergoing musculoskeletal procedures, prescriptions should last for 6 to 15 days. The findings are published in JAMA Surgery.

The median prescription lengths were:

  • 4 days for appendectomy, cholecystectomy and hysterectomy;
  • 5 days for inguinal hernia repair, mastectomy, anterior cruciate ligament repair and rotator cuff repair;
  • and 7 days for discectomy.

Virtually everyone agrees: Current opioid prescribing habits often end up dispensing more pills than necessary, which can lead to complications and dependence. But if prescribers become too stingy, legitimate concerns about sufficient pain management persist (not to mention concerns about middle-of-the-night phone calls).

The researchers reached their conclusions by looking at median prescription lengths for more than 200,000 patients, as well as the specific surgeries they'd undergone, and identifying the likelihood that they'd refill their prescriptions. The higher numbers in the ranges are based on minimum durations associated with the lowest risk of refills.

"Although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings and … sufficient for many common general surgery and gynecologic procedures," say the authors, "in the post-operative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive."

Jim Burger

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