Opioid prescribing is often excessive. Recent studies estimate that half to two-thirds of postoperative opioids remain unused, making them available for redistribution and misuse.

The VUMC Department of Plastic Surgery designed and implemented an opioid stewardship protocol, PICASSO (Plastic surgery Initiative to provide Controlled Analgesia and Safe Surgical Outcomes), which uses an algorithm to standardize analgesic prescribing after outpatient surgeries.

Plastic surgery chief resident S. Peir Johnson, MD, and colleagues compared prescribing patterns before and after implementation of PICASSO.

They report in the Annals of Plastic Surgery that PICASSO decreased the number of opioid prescriptions by 20%, without increasing refill rates. The protocol reduced the oral morphine equivalent per prescription by 2.5-fold, the equivalent of 18 5-milligram oxycodone pills, and increased prescriptions for the non-narcotic analgesics acetaminophen, ibuprofen, and gabapentin.

The authors conclude that an opioid-restrictive protocol can guide and improve postoperative analgesic prescribing culture.

—Leigh MacMillan