Recovery after heart surgery can be painful. Corn a new study suggests that patients do not need potentially addicting prescription opioids to control this postoperative discomfort.
“This study shows that discharge without opioid pain reliever after cardiac surgery is extremely well tolerated by some patients. In other words, we should not reflexively prescribe pain relievers to people after surgery just in case they need them. “said study author Dr. Catherine Wagner of the University of Michigan in Ann Arbor.
The new study was published online this week in The Annals of Thoracic Surgery. In the research, Wagner’s team analyzed data from more than 1,900 American patients who underwent heart bypass, heart valve surgery, or a combination of the two procedures.
All surgeries were performed using a vertical incision in the center of the thorax. The surgeries were performed at 10 Michigan medical centers in 2019.
More than a quarter – 28% – of patients did not receive opioid pain reliever prescription upon discharge, Wagner’s group noted.
Patients were less likely to have received a prescription for an opioid if they were older or had spent more time in the hospital after surgery.
“In some cases, patients assume that after surgery, especially a major operation like heart surgery, they will need to go home with prescription pain relievers,” Wagner said in a press release.
But his team found that less than 2% of patients who had not yet received an opioid prescription when discharged from hospital later found out that they needed an opioid before their appointment. 30-day follow-up.
The results “should reassure patients that postoperative pain can be managed at home with non-opioid pain relievers,” Wagner said.
Dr Yili Huang heads the Pain Management Center at Northwell Health’s Phelps Hospital in Hollow, NY.
“Studies have shown that about 10% of patients develop chronic opioid use after heart surgery, and this is strongly associated with the amount of opioids prescribed to them upon discharge,” Huang noted.
“Therefore, all the data showing that the reduction in opioids after heart surgery is encouraging,” he added.
Considering the level of postoperative pain often experienced by recovering patients, “the fact that nearly 30% of patients did not require prescription opioids after discharge is striking,” said Huang.
He pointed out that the average patient with a bypass or valve repair spends at least a week in the hospital after their surgery, and many may, in fact, receive an opioid during that time.
So, “opioid pain care always has a role to play in the immediate postoperative period – especially after cardiac surgery,” Huang said.
But the new study suggests that long-term opioid use after discharge from hospital isn’t always necessary, and “many patients don’t need prescription opioids for as long as we thought. originally, ”he said.
Dr Thomas MacGillivray, of Houston Methodist in Texas, was not directly involved in the study but was familiar with the results.
Speaking in the newspaper’s press release, he said: “For decades, surgeons have unwittingly but substantially contributed to the opioid epidemic.”
MacGillivray explained that “with the best intentions to help relieve pain and relieve pain anxiety, discharge practices have often erred in prescribing too much pain medication rather than too little. We have learned that many of the unused and unnecessary narcotics end up in the community. ”
“This very important study will help surgeons identify patients who can go home comfortably without the narcotics,” MacGillivray said.
According to recent data from the U.S. Centers for Disease Control and Prevention, at least 70% of U.S. drug overdose-related deaths in 2019 – about 49,000 lives lost – were opioid-related.
The US National Institute on Drug Abuse has more information on prescription opioids.
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