The Impact of Reducing Opioid Unit Dose Quantities on Perioperative Utilization and Pain Scores For Laparoscopic Cholecystectomies

Abstract

Aim: At our institution, reductions to hydromorphone and fentanyl unit dose quantities provided us with a unique opportunity to study opioid utilization. Materials&methods: A retrospective study examining effects of changes in opioid unit dose on intra-operative and postoperative opioid utilization in patients who underwent laparoscopic cholecystectomy. The study included three arms: the predosage change (n = 254), fentanyl only change group (n = 102) and the postdosage change arm (n = 254). Results: Decreasing opioid unit dosing decreased intraoperative opioid administration and total perioperative utilization. Decreased postanesthesia care unit morphine milligram equivalent (MME) requirements were observed in all, but one group comparison. Conclusion: Our data suggests that opioid unit dosing and administration are directly proportional and that decreased intraoperative MME utilization leads to decreased total perioperative MME use.

Plain language summary

This study suggests that by supplying anesthesia providers with smaller quantities of opioid pain medication for use during surgery less pain medication is used both during and after surgery without a resultant increase in a patient’s pain score or the amount of time they need to stay in the postoperative recovery area. As a result, some of the negative side effects associated with opioid pain medications may be diminished.

Keywords::

• opioids
• pain
• pain management
• postoperative pain

Author contributions

J Buehler conceived the study and oversaw overall direction and planning. T Indranoi and M Montgomery compiled the clinical data. A Pehrson and O Gulsah performed the computations and verified the analytical methods. CA Solla and A Pehrson wrote the manuscript in consultation with J Buehler and O Gulsah. All authors discussed the results and contributed to the final manuscript. CA Solla is responsible for the overall content as guarantor.

Acknowledgments

The authors would like to acknowledge P Allen for his mentorship in the development and implementation of this work through his participation in meetings related to this research.

Financial&competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

Retrospective study, no human or animal experimental investigations conducted. Chart review only, informed consent waived by institutional review board.