68 Pain Relief or Opioid Grief? a Reduction in Opioid Prescribing Following Gastro-Oesophagectomy

Abstract Aim This study aimed to evaluate post-operative opioid analgesic consumption and the necessity of opioid analgesic prescriptions on discharge in patients undergoing Ivor Lewis Gastro-oesophagectomy (ILGO) at a high-volume centre with the best UK length of stay. Method A retrospective review was conducted on ILGO patients from January to June 2023. Inclusion criteria were adherence to the ERAS programme, and discharge within 10 days; patients with complications or unplanned ICU admissions were excluded. Opioid analgesia use from postoperative day 5 to discharge was compared with opioid analgesia prescriptions issued on discharge. After the review, a prescribing tool for analgesia on discharge was implemented, and its impact evaluated. Results Of 34 patients, 24 met the inclusion criteria (mean age 68; 18 men, 6 women). Exclusions were due to delayed gastric emptying (6), unplanned ICU admission (1), and pneumonia (3). From day 5 to discharge, 63% (15/24) used no opioids, yet 87% (13/15) of these were still prescribed opioid analgesia on discharge. All 9 patients requiring opioids beyond day 5 had open chest surgery. Ten months after implementing the analgesia on discharge tool, 33% (5/15) were discharged with opioids. 20% (3/15) contacted their GP for stronger analgesia. Conclusions Most ILGO patients do not require opioids in later recovery, revealing significant overprescribing. The study led to revised prescribing guidelines, reducing opioid discharge prescriptions, pharmacy workload, and potential dependency risk. As a pilot with limited sample size, further research with larger datasets is needed to better define post-discharge analgesia requirements.