Standard Opioid Prescribing in Pediatric and Adolescent Gynecology [ID: 1381154

Abstract

INTRODUCTION: Enhanced Recovery After Surgery principles reduce opioid use postoperatively. There are no recommendations for optimal opioid dose prescribing for postoperative pain. The aim of this quality improvement project was to assess postoperative opioid use after pediatric gynecologic surgeries and establish standard opioid prescriptions across all surgeons based on procedural type. METHODS: Counseling on postoperative care including pain management was provided preoperatively and postoperatively. At the 2-week postoperative visit, patients were asked the number of opioid doses used and their pain control satisfaction. Baseline data were collected for 6 months with surgeons prescribing opioid doses via personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established with 10 doses provided for laparotomy with incision greater than or equal to 5 cm, 5 doses for laparoscopy or mini-laparotomy with incision(s) 4 cm or less, 5 doses for combined laparoscopic/vaginal approach, and 0 doses for vaginal cases. Data collection was repeated after implementation of standard opioid dose prescriptions. RESULTS: Complete data were recorded for 30 cases prior to implementation and 29 cases after implementation. Standard opioid dosing resulted in 30% decrease in total opioid doses (252–176 doses; P=.014) and 15% reduction in unused doses (162–137 doses). Forty-three percent of patients used no opioid doses. There was no significant difference in patient satisfaction (P=.014) in pain control. CONCLUSION: Application of standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient satisfaction. This quality improvement project suggests further reduction in standard dose prescriptions is possible.