• Gina Votta-Velis, Martha L Daviglus, Alain Borgeat, Katharina Beckmann, Andrew Q Ta, John L Parker, Sasha Kravets, Olga L Garcia, Amber Pirzada, Nicole Gastala, Valentina Valle, Jamie J Benken, Maya Campara, Gabriela Aguiluz, Stavros G Memtsoudis, Pier C Giulianotti, and Enrico Benedetti.
• Anesthesiology, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA ginavot@gmail.com.
• Reg Anesth Pain Med. 2023 Dec 1; 48 (12): 594600594-600.

IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.MethodsThis prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.ResultsPostoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: -0.58, 0.10; non-inferiority margin=-1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15) vs 8.17 morphine milliequivalents (MMEs) (IQR=40.33); p<0.01) and had fewer discharge prescription opioids (median=0 (IQR=60) vs 86.4 MMEs (IQR=140.4); p<0.01).DiscussionThe SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids.© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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