ith each passing day, the novel coronavirus disease 2019 (COVID-19) pandemic escalates around the world. First identified in Wuhan, China, the disease is caused by a novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 Globally, health care professionals have been infected at high rates (63% of all cases in Wuhan as of February 11, 2020, were health care professionals; in Italy, 20% of health care professionals responding to the pandemic were reported to be infected) and are also dying of COVID-19. [1][2][3][4][5] These high rates are likely due to transmission of the virus through droplet, contact, and even airborne modalities, similar to the 2002-2003 SARS pandemic, 6 as well as by asymptomatic individuals. A study by Zou et al 7 has shown similar viral loads present in both asymptomatic and symptomatic patients, with the highest viral load being identified in the nasal cavity. Subsequently, it is not surprising that otolaryngologists have been identified as a high-risk group among health care professionals, given their level of exposure to the upper aerodigestive tract. [8][9][10] The risk of infection for health care professionals is compounded by shortages of personal protective equipment (PPE), including filtering facepiece respirators (FFRs), in particular, N95 respirators. 2,11 Early studies report that adequate PPE and hand hygiene provide good protection from infection, especially in cases of high-risk procedures in which SARS-CoV-2 can be aerosolized. 12,13 The N95 respirators were widely used in previous SARS and influenza outbreaks to prevent both droplet and airborne transmission. 6,14 At UCLA Health, the use of N95 respirators along with a gown and eye protection or face shield is required for any invasive otolaryngologic procedure involving mucosal surfaces, in line with recent guidelines based on international experience. 8 In the US, the supply of necessary PPE has been unable to keep up with the rapid increase in the number of patients with COVID-19 owing to the disruption of the global supply chain. 2,15 The Centers for Disease Control and Prevention (CDC) has estimated that more than 90 million respirators would be required for health care professionals alone in a pandemic lasting 42 days. 16 As of March 2020, the US Department of Health and Human Services estimated that 3.5 billion N95 respirators would be needed in a severe event, but only 35 million were available. 17 Previously, the CDC set guidance for extending the use of single-use PPE in times of high demand and more recently released new guidelines on decontamination methods for N95 IMPORTANCE The novel coronavirus disease 2019 (COVID-19) has proven to be highly infectious, putting health care professionals around the world at increased risk. Furthermore, there are widespread shortages of necessary personal protective equipment (PPE) for these individuals. Filtering facepiece respirators, such as the N95 respirator, intended for single use, can be reused in times of need. We explore the evidence for dec...
Objective This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty. Methods Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone‐acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone‐acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non‐gabapentin groups. Results A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = −9.54, 95% C.I. = [−17.84, −1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = −1.59, 95% C.I. = [−5.03, 1.84], p = 0.36). Conclusion To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control. Level of Evidence 3 Laryngoscope, 133:1065–1072, 2023
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