Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

January 9, 2019

Avoid opioid-only modalities for post-operative pain control.

Opioid overdose has become one of the leading causes of injury related death in the United States and can be linked to the rising rates of opioid prescriptions. Many surgical patients report unused opioid prescriptions following surgery and there is a growing call for better standardization of opioid prescribing practices. Surgeons should utilize additional strategies such as locoregional anesthetic blocks and non opioid medications (acetaminophen, NSAIDS and gabapentoids) for pain management where possible.


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How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (comprised of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top five recommendations were then selected for inclusion in this list.

Sources

Bicket, M.C. et al., 2017. Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA surgery, 152(11), pp.1066–1071.

Dart, R.C., Severtson, S.G. & Bucher-Bartelson, B., 2015. Trends in opioid analgesic abuse and mortality in the United States. The New England Journal of Medicine, 372(16), pp.1573–1574..

Derry, C.J., Derry, S. & Moore, R.A., 2013. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane database of systematic reviews (Online), (6), p.CD010210.

Hill, M.V. et al., 2017. Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. Journal of the American College of Surgeons.