Fewer Opioids Following Hernia Repair May Be Sufficient: Study

Patients undergoing hernia surgery are routinely given opioid painkillers to control their pain following the operation. However, a new study indicates far fewer painkillers may be needed following hernia repair than surgeons previously believed were necessary, which should result in a re-evaluation of opioid prescriptions amid the epidemic of abuse and addiction in the United States. 

In a study published earlier this month in the medical journal Surgery, researchers from Massachusetts General Hospital and Newton-Wellesley Hospital indicated that nearly 60% of patients surveyed did not use all of the prescribed opioid painkillers following their surgery.

Researchers conducted an observational study between October 1, 2015, to September 30, 2016. They included 185 hernia surgery patients from a single-surgeon, high-volume practice of hernia repair operations.

All patients were prescribed 10 opioid painkiller tablets, or Vicodin, postoperatively. They were also advised not to take the narcotic painkillers if they could control their pain using non-opioid painkillers, like Tylenol or Advil. Patients completed a questionnaire at their post-op appointment, about two to three weeks after surgery.

In the medical community, researchers noted that it is very common for hernia patients to receive an average of 30 opioid tablets after surgery.

Overall, 60% of patients said they didn’t use narcotic painkillers at all. Nearly 86% used less than 4 opioid painkiller tablets. No patients reported needing or taking opioids the week before their post-op follow-up appointment.

More than half of patients completely relied on Tylenol and Advil, non-narcotic painkillers, to control their pain. These patients were less likely to have high levels of pain that were persistent. They also noted that their pain interfered less with daily activities and leisure activities than for patients who used opioids.

Only 13 patients said they needed nine or more opioid tablets. Among all the patients, those who were employed and worked post-op were more likely to take opioid painkillers.

About 75% reported missing more than 3 days of work, while 51% did not miss any work. About 67% of patients said the pain did not interfere with their daily lives, 23% said the pain slightly restricted their activities, and five patients said the pain significantly affected their daily activities.

Researchers said the findings indicate post-operative surgery pain and how to approach the pain with opioid painkillers should be researched further, focusing on efforts to reduce the amount of narcotic painkillers prescribed to patients.

While much of the attention concerning the opioid abuse epidemic has focused on the prescribing practices of primary care doctors, study authors highlighted research indicating surgeons may also play a role in opioid dependence.

Opioid dependence following surgery may be as high as 6%, mainly stemming from narcotic painkillers prescribed for surgery pain. Another study found that when doctors are monitored, they prescribed fewer narcotic painkillers to patients.

“The implication of our study is that, even though surgeons have been careful to limit the number of opioid tablets that we prescribe following operations, we may still be prescribing more medication than is actually needed by our patients,” says Peter Masiakos, MD, Department of Pediatric Surgery, MassGeneral Hospital for Children and lead author of the study.