May 22, 2019
A new pain management program implemented by Penn Medicine has limited the number of opioids prescribed to urologic cancer patients.
Medical guidelines recommend prescribing varying amounts of opioids to patients who undergo robotic surgery for urologic cancers, including prostate and kidney removals. Patients typically are prescribed 15 to 45 pills of oxycodone, an opioid used to relieve severe pain.
Penn Medicine's new program instead begins patients without narcotics, escalating pain medication only when necessary. Prescriptions for oxycodone – considered among the most addictive opioids – are handed out only as a last resort.
The program is the result of study conducted by researchers at the Perelman School of Medicine and aims to reduce opioid prescriptions, given the drugs' addictive powers. About six percent of cancer patients who first use opioids to manage pain following surgery become addicted.
The result? Between September and January, 68 percent of 170 urologic surgery patients went home without an opioid prescription. Only 8 percent were prescribed oxycodone – and they were only sent home with 10 pills, lower than the guideline-recommended amount.
The other 24 percent received 10 pills of tramadol, an opioid considered to have a lower risk of addiction and abuse.
Under the medical guidelines, all urologic surgery patients previously would have received oxycodone. Despite patients receiving different treatments, researchers did not observe any difference in the patients' pain scores.
"The key to our program was to start patients with over-the-counter medications, then escalate them as needed," said Dr. Ruchika Talwar, the study's lead author. "This means patients whose pain can be managed without opioids never end up getting them in the first place while patients whose pain warrants these prescriptions receive them when needed."
Under the new program, patients receive gabapentin and acetaminophen prior to surgery. They again receive the same drugs every eight hours following surgery, plus an IV dose of ketorolac. Patients who are still in pain are given tramadol.
If the pain persists, only then are they prescribed oxycodone.