Single Agent Opioid vs Combination Agent Opioids in Postoperative Pain Control




Aishat, Muhammad
Segovia, Alicia
Hamby, Tyler
Campbell, Throy
Brooks, Meredith
Gandhi, Artee


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Introduction: Treating post-surgery pain in pediatric populations often involves combination opiates, commonly hydrocodone and oxycodone. Unfortunately, this approach can lead to confusion for parents and concerns for overdose, as half of pediatric opioid prescriptions are considered high-risk. An opioid stewardship committee was established to oversee prescribing guidelines at Cook Children’s Medical Center (CCMC). This large-scale retrospective study examined whether educational interventions increased the likelihood of single-agent opioid prescriptions for post-surgery pain. This practice allows providers to more freely utilize NSAIDs and acetaminophen for postoperative pain. Methods: This was a retrospective single-center quality improvement (QI) project of all patients, who were prescribed opioids after surgery at CCMC in Fort Worth, TX between 3/1/2018 and 2/28/2022. Logistic regression was used to determine whether likelihood of single-agent (vs. combination) opioid prescriptions differed by intervention and department. Results: There were 5227 (38.30%) pre-intervention procedures and 8419 (61.70%) post-intervention procedures. Post-intervention procedures (vs. pre-intervention) were statistically significantly more likely to result in single-agent, rather than combination, opioid prescriptions (88.10% vs. 8.84%, OR=79.62, p<0.0001), and likelihood of single-agent opioid prescriptions significantly differed by department (p<0.0001). The proportion of single-agent opioids prescribed increased post-intervention in all 7 departments examined, and the proportion increased by 70% in the 3 departments with the most procedures: orthopedics, urology, and otolaryngology. Conclusion: Ongoing educational efforts by the Opioid Stewardship Committee have resulted in a sustained change in prescribing practices in multiple surgical departments from the use of combination to single-agent opioids.