Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Figures & data

Table 1. Examples of surgical procedures and their expected recovery times

	Expected rapid recovery	Expected moderate recovery	Expected long-term recovery
Definition	Patient resumes most normal activities within 2 weeks from surgery	Patient resumes most normal activities within 4 weeks from surgery	Patient resumes most normal activities after 4+ weeks from surgery
Number of opioid-containing tablets	0–3 days; maximum 12 tablets	7 days; maximum 30 tablets	14 days; maximum 60 tablets; split prescription (see Appendix)
Breast procedures	● Breast biopsy ● Lumpectomy (with or without sentinel lymph node biopsy) ● Sentinel lymph node biopsy ● Simple mastectomy (with or without sentinel lymph node biopsy)	● Mastectomy with reconstruction ● Modified radical mastectomy ● Axillary lymph node dissection
Cardiac procedures	● Cardiac catheterization	● CABG
General surgery procedures	● Cholecystectomy ● Appendectomy ● Inguinal/femoral hernia repair (open/laparoscopic) ● Umbilical hernia repair (open) ● Ileostomy/colostomy Cceation (lap) ● Colon or rectal resection (lap)	● Ileostomy/colostomy creation (open) ● Incisional hernia repair (lap or open) ● Small bowel resection or enterolysis (open) ● Low anterior resection (lap or open) ● Colon or rectal resection (open) ● APR	● Component separation and incisional hernia repair
Gynecological procedures	● Uncomplicated cesarean section ● Uncomplicated labor and delivery	● Vaginal hysterectomy ● Abdominal/open hysterectomy ● Laparoscopic and robotic hysterectomy
Neurosurgery and spine procedures	● Microdiscectomy (one level)	● Discectomy (open/multilevel) ● Laminectomy ● Craniotomy	● Lumbar fusion, major spine procedure
Orthopedic procedures	● Arthroscopic partial meniscectomy ● Carpal tunnel release ● Acute fracture (closed reduction, no surgery) ● Minor fracture ORIF (e.g., wrist, ankle, foot, patella, olecranon) ● Arthroscopic shoulder decompression	● Arthroscopic ACL/PCL reconstruction ● Arthroscopic or mini open rotator cuff repair ● Thumb reconstruction ● MTP fusion ● Major fracture ORIF (e.g., humerus, tibia, tibial plateau, pilon, femur) ● Hip fracture (ORIF or arthroplasty) ● Total hip arthroplasty ● Total shoulder or elbow arthroplasty ● Total ankle arthroplasty ● Amputation	● Total knee arthroplasty ● Osteotomies ● Revision surgeries for fracture nonunion ● Repair/reconstruction of multiligament knee injuries
Otolaryngology procedures	● Thyroidectomy, tonsillectomy ● Cochlear Implant		● Partial or complete neck dissection
Thoracic procedures	● VATS (video-assisted surgery: lobectomy/wedge resection, thymectomy)	● Thoracotomy	● Esophagectomy
Urological procedures	● Robotic retro pubic prostatectomy ● Vasectomy ● Transurethral resection of bladder tumor ● Ureteral stent placement ● Ureteroscopic stone extraction	● Robotic-assisted laparoscopic radical prostatectomy ● Robotic assisted laparoscopic partial nephrectomy ● Percutaneous nephrectomy ● Inflatable penile prothesis/malleable penile prothesis placement	● Open partial nephrectomy ● Open cystoprostatectomy with ileal conduit
Vascular procedures	● Endovascular thoracic/aortic aneurysm repair (EVAR/TEVAR) ● Upper extremity dialysis access creation ● Carotid endarterectomy	● Infrainguinal bypass ● Hybrid infrainguinal revascularization ● Thoracic outlet decompression ● Advanced endovascular aortic aneurysm repair (fEVAR, P-branch)	● Open aortic aneurysm repair ● Open thoraco-abdominal aneurysm repair ● Aorto/thoraco–femoral bypass

ORIF = open reduction and internal fixation; ACL = anterior cruciate ligament; PCL = posterior cruciate ligament; MTP = First metatarsal-phalangeal; APR = abdominal perineal resection; VATS = video-assisted thorascopic surgery; CABG = coronary artery bypass graft; EVAR = endovascular aortic repair; TEVAR = thoracic endovascular aortic repair; fEVAR = femoral endovascular aortic repair.

Table 2. Oral opioid analgesic conversion table

	Equivalence to oral morphine 30 mg	To convert to oral morphine equivalent, multiply by	To convert from oral morphine, multiply by
Morphine	30 mg	1	1
Codeine	200 mg	0.15	6.67
Oxycodone	20 mg	1.5	0.667
Hydromorphone	6 mg	5	0.2
Methadone and tramadol	Morphine dose equivalence not reliably established

Source: Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b08.html).