Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Abstract

Objective This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. Study Design Prospective cohort study. Setting Single tertiary‐care facility. Methods Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. Results Eighty‐six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). Conclusion The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.

Prednisone Decreases Opioid Use in Adults Undergoing Benign Oropharyngeal Surgery

“…Moreover, studies by Butkus et al and Dahm et al reported that 70% to 90% of patients reported keeping excess prescription opioids in their homes, which feasibly increases the possibility of abuse and diversion 15,24 . While our study did not survey patients on opioid disposal, the average amount of excess opioids was approximately 40%.…”

“…Moreover, studies by Butkus et al and Dahm et al reported that 70% to 90% of patients reported keeping excess prescription opioids in their homes, which feasibly increases the possibility of abuse and diversion. 15,24 While our study did not survey patients on opioid disposal, the average amount of excess opioids was approximately 40%. In the context of recent literature, this highlights the risk that opioid over-prescription poses on communities and underscores the importance of alternative pain management.…”

“…Opioid prescription research has increased in otolaryngology as clinicians become increasingly conscious of opioid stewardship. Many studies demonstrated significant variation in opioid prescribing practices in otolaryngology that ultimately resulted in substantial overprescription 6‐23 . Additional concerns arise regarding opioid excess from several studies that demonstrated a positive association between prescribed opioid doses and total consumption 13,20‐22 .…”

“…Numerous studies in otolaryngology suggest that many ambulatory surgeries can be managed with no minimal opioids and multimodal analgesia without compromising patient satisfaction 24‐44 . Additionally, multimodal analgesia has demonstrated superior pain control than monotherapies in the postoperative setting 15,24,31 . Corticosteroids present one mechanism that clinicians can leverage to reduce postoperative pain by reducing inflammation and edema 55 .…”

“…Methadone, hydrocodone, and oxycodone are the most common prescription opioids causing overdose death, the latter two of which are frequently prescribed after otolaryngology surgeries 1‐4 . Opioid prescribing rates have consistently declined in the last decade as a result of concerted opioid stewardship efforts in the medical community, with the implementation of opioid‐prescribing guidelines representing one way that providers regulate prescriptions to reduce variability and excess 3‐23 . For instance, the American Academy of Otolaryngology–Head and Neck Surgery released opioid prescribing guidelines in 2021 that recommend risk factor screening for opioid use disorder, nonopioid pain medications as first‐line treatment, and counseling about safe opioid storage and disposal for common otolaryngological surgeries 5 .…”