Opioid Prescription after Common Urgency General Surgery Procedures: An International Perspective
Noppakunsomboon N, MD1, Swangsri J, MD, PhD1, Sirivatanauksorn Y, MD, PhD1, Kongkaewpaisan N, MD1
Affiliation : 1 Division of Acute Care and Ambulatory Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : There are no guidelines for adequate postoperative pain control while lowering the risk of morphine overuse. To optimize
the utilization of morphine derivatives, the proportions of patients and morphine amounts prescribed postoperatively have been
studied worldwide. The present study reviewed the number of patients receiving morphine and the amounts administered at the
Department of Acute Care Surgery.
Materials and Methods : The use of postoperative oral morphine derivatives by patients undergoing common emergency general
surgeries was retrospectively reviewed. Electronic data were collected of patients undergoing open appendectomy, laparoscopic
appendectomy, laparoscopic cholecystectomy, open cholecystectomy, and open hernia surgery. The rates and amounts of the
morphine derivatives prescribed during hospitalization and at discharge were analyzed. The amounts of the derivatives were
converted to morphine milligram equivalents (MME).
Results : Opioid derivatives were prescribed postoperatively for 22 patients (3.8%), with an average of 2.4 MME. Eighteen patients
(3.1%) received intrahospital morphine derivatives (mean: 30 MME), while thirteen (2.2%) obtained them as a home medication
(mean: 67 MME). The overall length of stay was 3.2 days (1 to 33), and the mean last pain score was 0.5 (0 to 7). A multiple logistic
regression revealed that patients aged <60 years and with a BMI <25 had a higher proportion of morphine prescriptions.
Conclusion : On case-by-case adjustments, a trivial amount of morphine derivatives was sufficiently prescribed to deal with
postoperative pain following common general emergencies. The proportions of morphine prescriptions were higher among younger
patients and those with average BMIs.
Keywords : Postoperative opioids, Urgency surgery, Opioids prescriptions
