Eliminating Opiate Prescriptions in Children after Non-Perforated Appendectomy.

Background Opiates are the traditional treatment for postoperative pain. Recognition that increased availability of opiates in the community is associated with increased addiction has led to efforts to decrease postoperative opiate distribution. However, there are concerns that without opiates, pain relief may be inadequate. Study Design We analyzed opiate prescriptions to children who had undergone appendectomy during 3 time periods: prior to intervention (7/2012-2/2013), after opiate prescriptions were standardized and reduced (12/2016-12/2017), and after opiate prescriptions were eliminated (01/2018-12/2018). We determined how many opiate prescriptions had been written and how many had been filled in each time period. Patients were contacted by phone to identify their medication use and quality of pain management. Results Pre-intervention, 75 children underwent appendectomy, and all received opiate prescriptions with an average of 15 doses of Oxycodone prescribed per patient. After reduction, 208 children underwent appendectomy and 30% received opiate prescriptions for an average of 1.5 doses of Oxycodone per patient. After elimination, 270 patients underwent appendectomy and 3 patients (1.1%) received opiate prescriptions for an average 0.05 doses of Oxycodone per patient. Patients contacted by phone expressed no pain relief issues and no patients later needed opiates. Conclusion Using a step-wise process we have eliminated the use of opiates for post-discharge pain in children undergoing laparoscopic appendectomy. This intervention has resulted in the elimination of 4,035 doses of Oxycodone from the community over the study period while ensuring that postoperative pain control has been adequate.