Patient-Controlled Opioid-Free Surgical Pathway: A Quality Improvement Initiative

Introduction:

Although opioids are often prescribed during surgery, an increasing number of patients are requesting opioid-free surgery (OFS). Perioperative care is often protocol-driven and may not account for individualized preoperative directives. Consequently, patient requests to avoid opioids are not always consistently communicated across the surgical care team. Despite enhanced recovery after surgery (ERAS) protocols that use a multimodal approach and regional anesthesia, completely avoiding opioids to meet patient requests is not consistently achieved. This study aimed to assess the feasibility and outcomes of the Patient-Controlled Opioid-Free Surgical Pathway (PCOFSP) in fulfilling patients’ requests for opioid-free surgery.

Methods:

The PCOFSP is based on a multimodal approach, regional anesthesia, and the use of complementary techniques. It begins with proper patient identification, education, and coordination among the care team. The pathway was initiated in May 2024 using a Plan-Do-Study-Act framework. Descriptive statistics were used to summarize demographics and outcomes. Continuous variables are reported as medians with interquartile ranges (IQRs), and categorical variables are reported as frequencies and percentages.

Results:

Of 1,175 patients screened, 16.1% requested OFS. Median age was 66 years (IQR of 58–72); 59% were male. Overall, 74.1% underwent OFS, 18.5% received opioids intraoperatively or in the (P) ACU, and 7.4% withdrew. Success was highest in plastic (100%) and orthopedic surgery (82.4%) and lowest in urology (67.8%). Median length of stay was 1.1 days (IQR of 0.6–1.5). Complementary techniques included aromatherapy (n=157), nanotechnology patches (n=15), auriculotherapy and mindful breathing (n=4), and hypnosis or music therapy (n=2). Five patients re-enrolled for a second surgery.

Conclusion:

The PCOFSP enabled 74% of patients to undergo OFS. Our data suggest that, by integrating regional anesthesia, multimodal analgesics, complementary therapies, and effective communication, the PCOFSP allows patients to successfully undergo OFS.