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6ER-021 Opioid-sparing strategies for discharge analgesia prescribing in non-complex surgeries – a missed opportunity
  1. G Roberts1,
  2. N Scarfo1,
  3. K Figueroa1,
  4. M Geekie1,
  5. A Moore2,
  6. C Hall3,
  7. J Koerber4
  1. 1Flinders Medical Centre, Sa Pharmacy, Bedford Park, Australia
  2. 2University of South Australia, School of Pharmacy and Medical Sciences, Adelaide, Australia
  3. 3Flinders Medical Centre, Acute Pain Service, Bedford Park, Australia
  4. 4Flinders Medical Centre, Dept Anaesthesia, Bedford Park, Australia


Background and Importance Opioids are an integral element of post-operative management for moderate to strong pain. Despite their effectiveness they are associated with a range of adverse effects and excessive opioid prescribing has contributed to a widespread international crisis of addiction and overdose, including across Europe and in Australia. Even minor surgeries can serve as an initial event for opioid-naive patients to become persistent opioid users. In Australia, opioid-related harm and associated deaths have risen along with opioid prescribing.

Guidelines recommend paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the opioid analgesics use. NSAIDs in particular work synergistically with opioids, providing opioid-sparing effects. Usage in the final 24 hours of hospital admission guides decision-making around prescribing of discharge analgesia.

Aim and Objectives We retrospectively assessed analgesia use patterns in opioid-naive patients undergoing non-complex surgery (length-of-stay 1–4 days post-operatively). We had a particular focus on intermediary analgesia use (NSAIDs and tramadol) and possible NSAIDs contra-indications to short-term use.

Material and Methods Patients undergoing surgery under general surgical teams with a post-operative length-of-stay of 1–4 days were retrospectively identified using case mix codes. Use of opiods, non-steroidal anti-inflammatories, tramadol and paracetamol in the final 24 hours of admission were quantified along with possible contra-indications for use and discharge prescribing.

Results Of 1015 patients assessed there were 555 (55.7%) who were eligible for NSAIDs and/or tramadol and not prescribed this as an inpatient option, although 310 (55.9%) of these patients still received opioids.

In the final 24h of admission 759 patients with no contra-indication to NSAIDs or tramadol did not receive these medications but 314 (41.4%) still received discharge opioids.

79 (7.8%) patients required no opioid analgesia in the final 24 hours but were still prescribed opioid at discharge.

A further 122 (12.0%) were not prescribed inpatient paracetamol 31 (25%) but received discharge opioids.

Conclusion and Relevance There is an abundance of missed opportunity for opioid-sparing strategies to be employed in this cohort. These poor prescribing patterns were largely driven by engrained culture and/or junior prescriber unawareness of options. Further work is underway to define post-discharge analgesia use patterns in order to inform development of clinical decision support to address this issue.

Conflict of Interest No conflict of interest.

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