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October 13, 2018
10/13/2018 7:30:00 AM - 10/13/2018 9:00:00 AM
Room North, Room 22
Patient Perceptions and Expectations About Postoperative Analgesia
Nirmal B. Shah, D.O., Stephen F. Goldberg, M.D., Amir C. Dayan, M.D., Carrie Mok, B.S., Marc C. Torjman, Ph.D., Jaime L. Baratta, M.D.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Disclosures: N.B. Shah: None. S.F. Goldberg: None. A.C. Dayan: None. C. Mok: None. M.C. Torjman: None. J.L. Baratta: None.
Introduction The opioid epidemic is a leading public health problem in the U.S. [1]. Opioid related deaths have nearly quadrupled since 1999 [2].Physicians may be prescribing opioids for more than what is required for postoperative pain control, ultimately leading to increased risk for opioid abuse and addiction [3]. Understanding expectations of analgesics is critical, as patient pressure can influence prescribing patterns [4]. Management of post-op pain is challenging due to type of surgery, patient age, and pain threshold; however, one of the main factors leading to postoperative pain is patient expectations [5, 6]. Patient perceptions of perioperative pain medication are poorly understood. This survey aims to understand patient expectations of perioperative analgesics. Methods Following IRB approval, patients >18 years old scheduled for surgery were recruited. A 13-question survey was given in the pre-op area. 5 questions were used for analysis. Descriptive statistics were performed. Data are presented as percentages and means ± SD. Results 502 patients were surveyed. Demographics included age, gender, prior surgery, prior opioid use, and chronic pain history. 100% of patients believed they would receive analgesics after surgery. 37% believed they would receive Tylenol, 18% Motrin, 77% opioids.Figures 1 and 2 demonstrate a comparison between patients expecting vs not expecting specific analgesics to be prescribed at discharge in relation to which medications they believed would be effective vs ineffective. Figure 1 demonstrates that patients expecting to receive post-op opioid prescriptions believed opioids will be effective in controlling their pain (p<0.05). This difference in expectations was not observed in patients expecting prescriptions for non-opioids. Figure 2 illustrates that even patients not expecting to receive opioids postoperatively still believed opioids would be superior to non-opioid medications (p<0.05). Conclusion The results show patients expected to experience pain after surgery and be prescribed analgesics. Patients anticipated receiving analgesics they perceived most effective, which was most often an opioid. The perception of superior efficacy of opioids is worthy of further study as this is inconsistent with the literature, and education may be needed to bridge this gap. With increased use of multimodal techniques, patients will begin to accept non-opioid therapy after surgery. As the opioid crisis continues, cultural attitudes toward pain and medications will play a central role in reducing the prevalence of opioids in healthcare and society. References 1. Wilkerson RG, et al. Emergency Medicine Clinics of North America. 2016;34(2) 2. Centers for Disease Control and Prevention. Annual Surveillance Report of Drug-Related Risks and Outcomes — United States, 2017 3. Daily LR, et al. Gynecologic Oncology. 2017;145:168-169 4. Little P, et al. BMJ 2004;328:4445. Mancuso, C.A., et al. (2017). The Clinical Journal of Pain, 33 (2), 93-986. Tharakan, L., et al. Continuing Education in Anaesthesia Critical Care & Pain, 2015. 15, 4, 1, Pages 180-183

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