Acetaminophen-ibuprofen regimen lowers need for postoperative opioids

  • Sim V & al.
  • J Trauma Acute Care Surg
  • 1 Apr 2019

  • International Clinical Digest
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Takeaway

  • More than half of patients who received a 3-day course of acetaminophen and ibuprofen along with 5 days of prescription opioids after laparoscopic cholecystectomy and appendectomy did not need opioids for pain control.
  • Patients who did take the prescribed opioids only took an average of 1.8 pills after discharge.

Why this matters

  • 6% of surgical patients continue to use opioids 6 months after surgery, but there are no established evidenced-based guidelines for nonopioid pain control in postoperative outpatients.

Study design

  • 65 patients who underwent uncomplicated laparoscopic cholecystectomy or appendectomy received a 3-day regimen of ibuprofen and acetaminophen at the time of discharge.
  • An additional opioid prescription was given for breakthrough pain (5 pills of 5 mg oxycodone).
  • Primary endpoint: pain control at home.
  • Funding: None disclosed.

Key results

  • The visual analogue scale pain score at home significantly improved vs at the time of discharge (3.7 vs 5.5; P=.001).
  • Patients took an average of 1.8 oxycodone pills after discharge.
  • 51% of the patients did not take oxycodone pills.
  • 4 patients reported pain not being adequately controlled at home.
  • No patient returned to the emergency department or required additional opioid prescriptions.

Limitations

  • Observational design.

Coauthored with Antara Ghosh, PhD