Objectives/Hypothesis: The objective of this study was to demonstrate the impact of preoperative education, patient risk stratification, and a postoperative pain management protocol for common head and neck procedures on opioid prescribing patterns and postoperative pain reporting.Study Design: Retrospective cohort study. Methods: A postoperative pain management protocol was developed and implemented for patients undergoing head and neck surgical procedures. Medical charts were queried and postoperative patient satisfaction surveys were administered. Opioid prescribing patterns were evaluated in cohorts of patients undergoing procedures with anticipated mild pain (e.g., thyroidectomy, parotidectomy, lymph node biopsy) before and after the implementation of the protocol. Postoperative patient surveys were analyzed in the postimplementation group.Results: A total of 302 patients were included for analysis. One hundred fifty-four patients and 148 patients underwent surgery before and after the implementation of the protocol, respectively. There was a decreased incidence of oxycodonecontaining prescriptions (83% to 26%), and tramadol became the most common discharge medication (70%). There was a significant decrease in the total number of pills prescribed after the implementation of the protocol (34.71 to 25.36, P < .001). Ninety percent of patients reported high satisfaction (≥8) with pain management.Conclusions: This study shows that a comprehensive pain management protocol can significantly reduce the amount and potency of opioid pain medication prescribed after head and neck procedures while maintaining high patient satisfaction.
This case report describes an incident of myiasis in Oklahoma City, Oklahoma. Paramedics treated a 53-year-old man in the field when he suffered cardiac arrest. He was intubated by the paramedics and transported to an emergency room, where he received two stents and a balloon pump. He was found to have a GCS of three and remained in the hospital for 7 days before passing away. After his death, the breathing tube was removed, revealing the presence of several maggots. On closer inspection, the dipteran larvae were found in both the oral and nasal cavities. Four of these larvae were reared to adulthood and identified as Lucilia cuprina (Weidemann) (Diptera: Calliphoridae), commonly known as the Australian sheep blowfly, by the Biology Department of the University of Oklahoma. Based on the fly's life cycle and rate of development, the infestation is suspected to be hospital acquired.
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