Gastrointestinal| Volume 229, P283-287, September 2018

Patterns of opioid use and prescribing for outpatient anorectal operations



      Surgery for anorectal diseases is thought to cause significant pain postoperatively. There is little known regarding standardized opioid-prescribing trends and patient use following surgery for anorectal diseases. We aimed to evaluate and analyze opioid-prescribing trends and patient use for outpatient anorectal operations.

      Materials and methods

      All patients who underwent outpatient anorectal surgery performed over a 1-y period at a single institution were eligible. Procedures included hemorrhoidectomy, anal fistula repair/seton, anal fissure treatment with sphincterotomy, and transanal excision of rectal tumors. Demographic, operative, and postoperative data were obtained. Patients were given a survey to determine postoperative pain control with opioid and non-narcotic analgesia use; respondents were included in analysis.


      Forty-two outpatient anorectal surgery patients were included: 13 had hemorrhoidectomy, 22 had anal fistula repair/seton, one had sphincterotomy, and six had transanal excisions. All patients had multimodality treatment with either an anal block and/or postoperative nonopioid analgesics. Ninety percent were prescribed opioids postoperatively with a median of 20 pills (range: 0-120 pills). Forty-three percent (18/42) did not fill their prescription. For those who used opioids, the median number of pills taken was four. Eighty percent of pills prescribed were not used. One patient required a refill. Greater than 60% of respondents reported good to excellent pain control on a five-point scale.


      Most patients had adequate pain control after anorectal surgery with little to no use of opioids and that more than 80% of opioid pills prescribed were not consumed. We intend to standardize our prescribing opioid quantities for outpatient anorectal operations to reflect this reduced use.


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        • Centers for Disease Control and Prevention
        Wide-ranging online data for epidemiologic research (wonder), multiple-cause-of-death file, 2000–2014.
        (Available at:)
        • Meyer R.
        • Patel A.M.
        • Rattana S.K.
        • Quock T.P.
        • Mody S.H.
        Prescription opioid abuse: a literature review of the clinical and economic burden in the United States.
        Popul Health Manag. 2014; 17: 372-387
        • Compton W.M.
        • Jones C.M.
        • Baldwin G.T.
        Relationship between nonmedical prescription-opioid use and heroin use.
        New Engl J Med. 2016; 374: 154-163
        • Manchikanti L.
        • Standiford H.
        • Fellows B.
        • et al.
        Opioid epidemic in the United States.
        Pain Physician. 2012; 15: ES9-ES38
        • Rudd R.A.
        • Aleshire N.
        • Zibbell J.E.
        • Gladden R.M.
        Increases in drug and opioid overdose deaths-United States, 2000-2014.
        MMWR Morb Mortal Wkly Rep. 2016; 64: 1378-1382
        • Center for Disease Control and Prevention
        Synthetic opioid data.
        (Available at:) (Accessed March 6, 2018)
        • US News
        (Available at:) (Accessed March 6, 2018)
        • The New York Times
        (Available at:) (Accessed March 6, 2018)
        • Dart R.C.
        • Surratt H.L.
        • Cicero T.J.
        • et al.
        Trends in opioid analgesic abuse and mortality in the United States.
        N Engl J Med. 2015; 372: 241-248
        • Morone N.E.
        • Weiner D.K.
        Pain as the fifth vital sign: exposing the vital need for pain education.
        Clin Ther. 2013; 35: 1728-1732
        • Joshi G.P.
        • Neugebauer E.A.M.
        Evidence based management of pain after hemorrhoidectomy surgery.
        Br J Surg. 2010; 97: 1155-1168
        • Stanek J.J.
        • Renslow M.A.
        • Kalliainen L.K.
        The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.
        J Hand Surg Am. 2015; 40: 341-346
        • Lev R.
        • Lee O.
        • Petro S.
        • et al.
        Who is prescribing controlled medications to patients who die of prescription drug abuse.
        Am J Emerg Med. 2016; 34: 30-35
        • U.S. Food and Drug Administration
        Fact sheet-FDA opioid action plan.
        (Available at:)
        • Bharucha A.E.
        • Wald A.
        • Enck P.
        • Rao S.
        Functional anorectal disorders.
        Gastroenterology. 2006; 130: 1510-1518
        • University of North Carolina Hospitals Pharmacy and Therapeutics Committee
        Opiate equianalgesic dosing chart.
        (Available at:)
        Disposal of unused medicines: what you should know.
        (Available at:)
        • Hill M.V.
        • McMahon M.L.
        • Stucke R.S.
        • Barth Jr., R.J.
        Wide variation and excessive dosage of opioid prescriptions for common general surgical procedure.
        Ann Surg. 2017; 265: 709-714
        • Rodgers J.
        • Cunningham K.
        • Fitzgerald K.
        • Finnerty E.
        Opioid consumption following outpatient upper extremity surgery.
        J Hand Surg Am. 2012; 37: 645-650
        • Kehlet H.
        • Dahl J.B.
        The value of “multimodal” or “balanced analgesia” in postoperative pain control.
        Anesth Analg. 1993; 77: 1048-1056
        • Hero J.O.
        • McMurty C.
        • Benson J.
        • Blendon R.
        Discussing opioid risks with patients to reduce misuse and abuse:evidence from 2 surveys.
        Ann Fam Med. 2016; 14: 575-577
        • Hill M.V.
        • Stucke R.S.
        • McMahon M.L.
        • Beeman J.L.
        • Barth R.J.
        An educational intervention decreases opioid prescribing after general surgical operation.
        Ann Surg. 2018; 267: 468-472