Opioids generally not needed after appendectomies

A retrospective study in 73 patients aged from 5 to 20 years who underwent laparoscopic appendectomy found that after hospital discharge (within 2 days of surgery) most patients had adequate analgesia without being prescribed opioids.

The study included extensive chart review-operative details, final pathology, postoperative course, inpatient and postdischarge opioid use, acetaminophen and ibuprofen prescriptions, and unplanned postoperative medical services. The 73 patients had a mean age of 12.1 years and were mostly male (69.9%); 49 of participants also completed postoperative phone interviews.

Of the total study group, 30 (41%) received inpatient opioids after surgery; 9 (12.3%) were given a prescription for an opioid on discharge; and 43 patients (58.99%) were given a prescription for acetaminophen or ibuprofen on discharge. Of those contacted by phone after leaving the hospital, most were reasonably comfortable, with about three-quarters having no desire for an opioid medication. Almost 90% of patients interviewed used acetaminophen or ibuprofen postoperatively.

Investigators interviewed 7 of the 9 patients who received outpatient prescriptions for an opioid. Of these 7, only 5 filled their prescription and 4 used them. The 5 patients who used an opioid upon discharge (1 patient used a parent’s leftover prescription) consumed an average of about 3 pills of oxycodone during 3 days. The opioid users were significantly older than the general appendectomy population, with a mean age of 15.8 years, and were discharged earlier.

The researchers noted that results of this study provide a framework for appendectomy postoperative opioid prescription in the pediatric, adolescent, and young-adult populations. They suggest prescribing acetaminophen and ibuprofen for all patients and no more than 3 pills of 5 mg of oxycodone for those likely to have the most postoperative pain. This group includes male teenagers, early postoperative discharges, and individuals who took inpatient opioids after surgery (Freedman-Weiss MR, et al. J Pediatr Surg. 2020;55[1]:106-111).

Thoughts from Dr. Farber

I still see patients who are being given opioids, sometimes in large amounts, by doctors (and dentists) when they are not needed. Ibuprofen has been shown to be fine for most of these cases (eg, broken bones). If you see a doctor who is still doing this, please share this article with them.