Design Cuts | SafeOp

1. Patient education

1.1. Patients and their families and/or caregivers should be provided with written and verbal information on their pain management options preoperatively, including:

Expectations regarding functional recovery (returning to meaningful physical activities)
Realistic pain management goals (goal is function, not zero pain)
Multimodal pain management options (e.g., opioid options, nonopioid options, and non-pharmacological options)
Possible interaction of patient’s current medications and their potential interactions with opioids (e.g., sleeping pills, alcohol, benzodiazepines)
Risk of potential opioid side effects, overdose, and development of a dependence or addiction
Safe opioid use and discontinuation
Risk factors for opioid use disorder (history of substance use disorder, depression, anxiety).

1.1.1. This information should be reinforced and reviewed prior to discharge.

1.2 Patients should be provided with written and verbal information prior to discharge on the safe storage and disposal of unused opioids in accordance with Health Canada’s recommendations.

1.2.1. Store opioids in a secure place to prevent theft or accidental exposure.

1.2.2. Keep opioids out of sight and reach of children and pets.

1.2.3. Do not keep opioid medications for when they“might” be needed.

1.2.4. Do not throw opioids into household trash where children and pets may find them.

1.2.5. Do not flush opioids down the toilet.

1.2.6. Return expired, unused, or used opioids to a pharmacy for proper disposal.

2. Risk factors for persistent postoperative opioid use

2.1. Preoperatively, patients should be assessed for the following risk factors because they may be at increased risk for persistent postoperative opioid use:

Surgical procedures associated with significant nerve damage that may put patients at risk to develop neuropathic pain
History of or concurrent anxiety and/or depression and/or high levels of pain catatrophizing and/or posttraumatic stress disorder
Use of medications for depression and/or anxiety (e.g., benzodiazepines and selective serotonin reuptake inhibitors)
Currently or previously followed and treated for chronic pain under medical supervision
History of drug use, smoking, and/or alcohol use disorder (previously or currently)
Low socioeconomic status
Aged 18–30 years old.

2.1.1. If a patient is at risk for persistent opioid use, a tailored opioid-sparing perioperative pain management plan should be developed by the perioperative team (including surgeons, anesthesiologists, and/or the pain team) preoperatively.

3. Discharge prescriptions for pain management after elective surgery

3.1. Nonopioid therapy should be the first-line of treatment for pain. Therapies can be pharmacological (e.g., nonsteroidal anti-inflammatory drugs [NSAIDS], acetaminophen, or regional
anesthetic techniques) or nonpharmacological (e.g., physical therapy, ice/heat, elevation, breathing exercises, meditation, etc.).

3.2. Patients should be discharged with a prescription for the following adjunct pain medications unless contraindicated:

Acetaminophen 1 g PO TID to QID for 7 days then PRN.
NSAIDS (e.g., naproxen 500 mg BID or ibuprofen 400 mg QID) PO for 3 days then PRN.

3.2.1. Patients should be counseled on how to take scheduled medications and advised to stop taking these medications after
7 days if they are expected to have a rapid recovery or after 14 days if they are expected to have a moderate or long-
term recovery.

4. Follow-up and long-term opioid use

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