Blueprint to Curb Postop Opioids After Pancreatic Resection

Roxanne Nelson, RN, BSN

September 12, 2023


Implementing a post-surgery protocol that has undergone incremental changes over time significantly reduced inpatient and discharge opioid volumes while maintaining pain control after pancreatic cancer surgery.


  • To reduce opioid dependence, misuse, and diversion, CDC guidelines emphasize strategies to minimize opioid prescribing for managing pain. Still, opioid prescribing following surgery remains common practice.

  • In the current study, a team of researchers implemented a recovery care pathway to reduce opioid use among 832 patients undergoing pancreatic resection at a comprehensive cancer center.

  • The study evaluated three sequential protocols implemented over a period of about 6 years, from 2016 to 2022.

  • In the final version, a standardized three-drug nonopioid bundle (acetaminophen, celecoxib, and methocarbamol) was initiated intravenously in the recovery room, after which the patient was given oral agents on postoperative day 1.

  • The primary outcome measure was inpatient and discharge opioid volume in oral morphine equivalents (OMEs) across the three pathways.


  • Opioid use significantly decreased with each sequential pathway refinement.

  • For inpatients, total OME decreased by more than 55% across the pathways from a median of 290 mg to 184 mg and finally to 129 mg (P < .001).

  • Median discharge OME dropped from 150 mg to 25 mg and then to 0 mg across the pathways (P < .001).

  • With the final version of the pathway, more than half of patients (52.5%) had opioid-free discharges, compared with only 7.2% in the first pathway. Pain scores remained stable at 3 or less; the number of postdischarge refill requests was unchanged.


"Our findings suggest that reduction of postoperative opioid dissemination through opioid-free discharge after pancreatectomy and other major cancer operations may be realistic and feasible by following this no-cost blueprint," the authors concluded. In an accompanying editorial, Melissa Hogg, MD, from NorthShore University Health System in Evanston, Illinois, said the "study inspired me to update our institution's [early recovery after surgery] protocol to reduce and eliminate opioid prescriptions."


The study was led by Ching-Wei D. Tzeng, MD, of the University of Texas MD Anderson Cancer Center, Houston. It was published online in JAMA Surgery on September 6.


The study evaluated the opioid protocol at a single center, which may limit the generalizability of the findings. The researchers did not receive patient feedback on pain control expectations or postoperative quality of life.


Tzeng reported receiving consultant fees and a sponsored research agreement from PanTher outside the submitted work. Hogg reported receiving training and travel funds from Intuitive Money. No other disclosures or outside funding were reported.

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