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  • Opioids After Corneal Surgery

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, January 2020

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    In a study of adults undergoing corneal surgery, Woodward et al. looked at the effect of reducing the usual number of prescribed opioid tablets on patients’ post-op consumption of the drugs. Cohort 1 received the typical number of tablets; cohort 2 received significant­ly fewer. On average, the first cohort used twice as many pills as the second cohort.

    For this prospective study, the first of two cohorts was surveyed to assess the quantity of opioid tablets used after routine corneal surgery, for which the standard number of pills was prescribed. Subsequently, the number of prescribed tablets was decreased, and patients in cohort 2 received a lesser quantity. Concurrently, a statewide monitoring program began providing patients with additional information on pain control, opioid use, and opioid disposal. The study’s main outcome was the differ­ence in tablet use by the two cohorts, determined by the two-sample t test.

    The overall study population included 82 patients (51% male). The mean age was 42.5 years. There were 38 patients in the first cohort and 44 in the second. Cohort 1 was prescribed significantly more tablets than cohort 2 (18.8 vs. 6.6; difference, 12.2 [95% confidence interval (CI), 10.4-14.0]; p < .001) and consumed more tablets (8.3 vs. 4.0; difference, 4.3 [95% CI, 1.4-7.2]; p = .005). Cohort 1 also had significantly more unused tablets (10.3 vs. 2.9; difference, 7.5 [95% CI, 4.7-10.2]; p < .001).

    Of the patients in cohort 2, pain control reportedly was adequate for 70% and more than needed for 22%. Twenty patients in this cohort had tab­lets left over—and of these, 17 did not dispose of the remaining tablets, and the remaining three discarded them.

    This study shows that pain control after corneal surgery generally is adequate or better even if patients are prescribed fewer opioid tablets. However, because the patients did not properly dispose of unneeded tablets, the authors recom­mend that physicians encourage safe opioid storage and disposal. They em­phasized that “ophthalmologists should balance patients’ pain control needs with opioid tablet prescribing after ophthalmic surgical procedures.”

    The original article can be found here.