Objective Quantification of Opioid Usage After Thyroid Surgery

Abstract

Introduction: It is well established that America is in the midst of an opioid crisis with 46 people dying every day from overdoses involving prescription opioids. In the last 2 years, multiple articles have been published indicating that the amount of opioid pain medication needed after discharge from thyroid and parathyroid surgery is low. Objective: To objectively examine the amount of opioid pain medication required by patients in our practice after thyroid surgery. Methods: Patients were given a standardized discharge prescription of 30 pills with a combination of 7.5 mg of hydrocodone and 325 mg of acetaminophen after thyroid surgery. They were asked to log the number of pills consumed per day and the level of pain per day using the Wong-Baker faces pain scale. We used in-office pill counts to ensure accuracy of the logs. Results: While reaching a similar conclusion, the present study is the first to objectively examine the quantity of opioid pain medication consumed between postoperative discharge and office follow-up. Our study objectively demonstrates that 85% of patients consumed less than 75.0 morphine milligram equivalent (MME) after thyroid surgery using in-office pill counts. Conclusion: Recent multimodality anesthesia research appears promising to dramatically reduce or even eliminate the need for opioid prescriptions upon postoperative discharge.

Nonopioid Versus Opioid Analgesics After Thyroid and Parathyroid Surgery: A Systematic Review

“…The opioid crisis is an ongoing public health issue in the United States, and persistent usage of postoperative prescription opioids after the original indication is a major contributing factor 17,18 . In light of this issue, the 2021 AHNS consensus statement recommended against routine opioid prescription for first‐line pain management after thyroid and parathyroid surgery, 11 referencing studies that demonstrated low analgesic demand among these patients 8‐10 . For example, Tharakan et al reported that 80% of the opioids that were prescribed at their institution for pain after thyroid and parathyroid surgery were not used by patients 12,13 .…”

“…4,5 Most thyroid and parathyroid surgery is performed in the ambulatory setting, 6 and as a result, pain is usually managed with oral medications that are taken after discharge. 7 While studies have demonstrated that patients take few, if any, of the opioid medications they are prescribed, [8][9][10] an optimal postoperative pain regimen has not been described, and remains largely dictated by provider or institutional preference.…”

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

“…The study's main limitation was the lack of data on the opioid quantity being consumed by patients after discharge. Studies such as that by Agnew and colleagues 11 would be beneficial in determining opioid use from patient and/or practitioner survey data.…”

“…The clinical practice guideline published in April 2021 by the American Academy of Otolaryngology−Head and Neck Surgery provides detailed recommendations for safely prescribing opioids for common otolaryngologic procedures. Several studies have examined the prescribing practices of surgeons after standard thyroidectomy and parathyroidectomy procedures to identify the postoperative opioid needs of patients; very little, if any, opioid medication is required after these procedures . The American Head and Neck Society Endocrine Surgery Section released a consensus statement in 2021 detailing recommendations for standard thyroidectomy and parathyroidectomy procedures …”

“…Several studies have examined the prescribing practices of surgeons after standard thyroidectomy and parathyroidectomy procedures to identify the postoperative opioid needs of patients; very little, if any, opioid medication is required after these procedures. [6][7][8][9][10][11][12] The American Head and Neck Society Endocrine Surgery Section released a consensus statement in 2021 detailing recommendations for standard thyroidectomy and parathyroidectomy procedures. 13 Despite these successful efforts in the field of head and neck surgery, the data on postoperative opioid needs for more extensive thyroid cancer procedures remain sparse, particularly for lateral neck dissection, which is commonly performed in conjunction with thyroidectomy.…”