Real-Time Pain Control Education After Outpatient General Surgery: A Randomized Controlled Trial.

Abstract

Introduction: Opioid-related morbidity and mortality continue to rise with surgery often serving as the first exposure to opioids for patients. Few interventions focus on real-time education in the outpatient setting while patients are experiencing pain. The effect of short-messaging service (SMS) surveys with real-time opioid-use education (SMSE) and without (SMS) on outpatient postoperative opioid use was studied.

Methods: A double-blinded randomized controlled trial enrolled adults (≥18 y) who underwent outpatient general surgery procedures from January 1, 2020, to January 2, 2021. Participants received an automated daily SMS or SMSE for 10 d postoperatively. Primary outcomes included total opioid use in oral morphine equivalents (OMEs) and total pain scores. Data were gathered via real-time SMS patient responses.

Results: One hundred sixty patients were randomized to SMS (n = 82) or SMSE (n = 78). Patient demographic/clinical characteristics and surgery type were similar. Between SMS and SMSE, there were no differences in total pain scores (25 [interquartile range (IQR): 25.0] versus 31 [IQR: 35.7], P = 0.291) or total OME used (15.5 mg [IQR: 37.5] versus 15.8 mg [IQR: 45.6], P = 0.762). Increased total OME correlated with younger age (P = 0.001), opioids prescribed (P = 0.001), and preoperative opioid use (P = 0.018). Higher patient satisfaction was observed in patients with lower total pain scores and OME used, with no difference in opioids prescribed (P = 0.352). Subgroup analysis revealed open hernia repair patients in the SMSE group had lower OME used (0 mg [IQR: 0] versus 14.2 mg [IQR: 11.6], P = 0.004).

Conclusions: Real-time opioid-use education via SMS did not lead to a difference in opioid use, but demonstrated a high acceptance rate as a mode of communication and feedback. This finding should encourage further optimization of the SMS tool to rapidly identify patients with inadequate pain control while promoting appropriate opioid use and disposal.