Richard Barth, MD, FACS



A study led by a Dartmouth-Hitchcock doctor showed high levels of satisfaction of pain management for patients after major surgery, despite being given fewer quantities of prescription opioids to take home.

Section Chief of General Surgery Richard J. Barth Jr., MD, and a team of Dartmouth-Hitchcock researchers developed tailored prescribing guidelines based on the number of opioids patients had taken on the day before they were discharged from Dartmouth-Hitchcock Medical Center (DHMC), rather than a standard prescription providing more pills than necessary.

“This guideline was designed to satisfy the pain management needs of about 85% of patients,” Barth said in a news release. “In this new prospective study, we found that 93% of patients had their post-surgery opioid needs satisfied.”

Barth and his team’s research also involved new protocols to encourage proper disposal of unused opioids. Sixty percent of study participants still had leftover pills, so a drop-off box for unused drugs was installed in the DHMC pharmacy, located near the surgeons’ outpatient offices.

A phone call before the post-surgery follow-up appointment also reminded patients to bring their unused pills with them to dispose.

These measures, coupled with education for patients about diversion and abuse of leftover opioids, resulted in 83% of patients with extra pills disposing of them safely – substantially higher than rates of safe disposal in the 20% to 30% range reported by other investigators who relied on patient education alone.

According to the news release, Barth’s study is unique in that it was prospective of a post-surgery pain management guideline that takes into account an individual patient’s perception of pain.

Barth, who specializes in surgical oncology, said that surgeons play a pivotal role in minimizing opioid use in their patients by setting expectations for pain management.

That discussion involves letting patients know they are likely to be discharged with either no opioids or a small amount based on their opioid use on the day before they go home.

“Explain to the patient, ‘We’ve studied this issue; we’ve figured out how many opioids you are likely to need,’” Barth said in the news release.

“The other part of that discussion involves letting patients know that they should expect some pain, and that our goal isn’t to get rid of all of their pain.

“That was something that surgeons tried to accomplish years ago, but that’s not what we’re aiming for now. A low level of discomfort is acceptable, and patients need to have that expectation.”

The study’s findings were recently published online in advance of print in the Journal of the American College of Surgeons.

Wednesday, April 21, 2021

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