Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;25(5):976-983.
doi: 10.1111/codi.16493. Epub 2023 Feb 15.

Feasibility of opioid-free surgery for inflammatory bowel disease

Adam Truong  1 , Lucille Yao  1 , Phillip R Fleshner  1 , Karen N Zaghiyan  1
Affiliations

Feasibility of opioid-free surgery for inflammatory bowel disease

Adam Truong et al. Colorectal Dis. 2023 May.

Abstract

Aim: Patients undergoing colorectal surgery or those with inflammatory bowel disease (IBD) are particularly at risk for opioid-related complications and progression to long-term opioid dependence. The aim of this work is to explore the real-world possibility of perioperative opioid avoidance in colorectal surgery and IBD.

Method: We conducted a retrospective analysis of patients aggregated from two prospective studies on multimodal postoperative pain control conducted at a single tertiary referral centre. All patients underwent major colorectal surgery with bowel resection. Patients with chronic preoperative opioid use were excluded. Opioid use was measured in oral morphine equivalents (OME) each postoperative day (POD) and cumulatively for the first 72 h.

Results: Our cohort of 209 patients included 148 (71%) with IBD and 61 (29%) non-IBD patients. IBD patients required significantly more opioids cumulatively over the first 72 postoperative hours compared with non-IBD patients [median OME 77 mg (interquartile range 33-148 mg) vs. 4 mg (interquartile range 17-82 mg), respectively; p = 0.001]. Five percent of IBD patients achieved opioid-free postoperative pain control during the entire 72 h postoperative period compared with 12% of non-IBD patients. Only 7% of IBD patients avoided opioid use on POD 1 compared with 20% of non-IBD patients (p = 0.02); however the number of IBD patients increased to 16% on POD 2 then 40% on POD 3, closely resembling the non-IBD cohort at 49% (p = 0.22).

Conclusion: In the era of modern enhanced recovery protocols and minimally invasive techniques, we show that early postoperative opioid avoidance is feasible in a limited number of IBD patients after colorectal surgery.

Keywords: IBD; opioid-free surgery; opioids; outcomes; smoking.

PubMed Disclaimer

References

REFERENCES

    1. Centers for Disease Control and Prevention (CDC). The drug overdose epidemic: behind the numbers. 2020. [online] Available from: https://www.cdc.gov/opioids/data/index.html. Accessed 15 May 2022.
    1. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers-United States, 1999-2008. Morb Mortal Wkly Rep. 2011;60(43):1487-92.
    1. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths-27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65:837-43.
    1. O'Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region-United States, 2006-2015. Morb Mortal Wkly Rep. 2017;66:897-903.
    1. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New persistent opioid use after minor and major surgical procedures in US. JAMA Surg. 2017;152(6):e170504. https://doi.org/10.1001/jamasurg.2017.0504

MeSH terms

LinkOut - more resources