Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery

Abstract

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

“…Recently, opioid prescribing guidelines have been successfully employed to reduce opioid excess, and the average postoperative MME prescribed has declined each year since 2015. 15,19,[35][36][37] As otolaryngologists reduce opioid prescriptions, there is a need to validate alternative therapies that appropriately manage postoperative pain and maintain patient satisfaction. Several studies suggest that many ambulatory surgeries can be managed without opioids and that otologic surgeries confer mild postoperative pain.…”

“…As our cohort demonstrated similar behavior, the risk of subsequent misuse or diversion is prevalent and presents great opportunity for patient education about proper opioid disposal. Recently, opioid prescribing guidelines have been successfully employed to reduce opioid excess, and the average postoperative MME prescribed has declined each year since 2015 15,19,35‐37 …”

Opioid-Sparing Pain Control after Rhinoplasty: Updated Review of the Literature

“…[13][14][15] Common opioids prescribed include tramadol, oxycodone, hydrocodone-acetaminophen, and oxycodone-acetaminophen with the number of tablets ranging from 10 to 40 tablets. [3][4][5][6][7][9][10][11][15][16][17][18][19][20][21][22][23][24][25][26] Patient-reported opioid use after rhinoplasty starkly contrasts the liberal prescription of opioids by providers. Patients routinely report taking < 50% of opioids that they are prescribed with several studies concluding that a postoperative prescription of 15 tablets provides sufficient pain control for 90% of patients.…”

Impact of state legislation and institutional protocols on opioid prescribing practices following pediatric tonsillectomy

“…Hospital systems have also implemented surgery-specific standardization protocols to reduce variability associated with post-surgical opioid prescribing. [20][21][22][23] Our institution introduced comprehensive recommendations to reduce opioid overprescribing across pediatric surgical specialties in early 2020.…”