Pain management and prescribing practices in otolaryngology residency programs

Klimczak, Jaclyn; Badhey, Arvind; Wong, Anthony; Colley, Patrick; Teng, Marita S.

doi:10.1016/j.amjoto.2019.07.009

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Indeed, 2 recently published reports examined prescribing patterns among otolaryngologists and trainees and noted significant variability in the type and quantity of opioid prescribed, 21 as well as a strong tendency toward overprescribing. 24 While these and other studies 19,22,23 have commendably sought to identify opportunities for decreasing the quantity of opioids prescribed, realizing the goal of ''appropriate'' opioid prescribing is impossible without first characterizing ''typical'' postoperative pain. The present study is one of the first in this country to critically examine several routinely performed procedures across multiple subspecialties within ORL, with respect to postoperative pain profiles, prescribing behaviors, and opioid usage.…”

Section: Discussionmentioning

confidence: 99%

“…14 Approximately half of the respondents, for example, prescribed over 20 opioid doses to patients after endoscopic sinus surgery. While several studies have independently examined pain [15][16][17][18] or opioid prescribing [19][20][21][22][23][24] after ORL procedures, few have correlated opioid use with perceived pain or prescription quantity with actual opioid consumption. This is essential for developing an evidence-based approach to postoperative pain management.…”

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confidence: 99%

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Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Kim¹,

Kacker²,

Kutler³

et al. 2020

Otolaryngol.--head neck surg.

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Objective To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors. Results A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required. Conclusion Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Kim¹,

Kacker²,

Kutler³

et al. 2020

Otolaryngol.--head neck surg.

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“…Other reports surveyed surgery or ophthalmology trainee opioid and pain management prescribing practices, perceived influences, and knowledge of prescribing resources. [13][14][15][16] Additionally, one report evaluated surgical resident prescribing practices via survey immediately before and after a one-hour didactic training focused on opioid prescribing best practices that found trainees answered with more non-opioid pain management options and reduced tablets prescribed when an opioid was selected to be used. 17…”

Section: Discussionmentioning

confidence: 99%

Emergency Medicine Intern Education for Best Practices in Opioid Prescribing

et al. 2021

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Introduction: Opioid exposure has been identified as a contributing factor to the opioid epidemic. Reducing patient exposure, by altering heavy opioid prescribing patterns but appropriately addressing patient pain, may represent one approach to combat this public health issue. Our goal was to create and implement an opioid education program for emergency medicine (EM) interns as a means of establishing foundational best practices for safer and more thoughtful prescribing.Methods: This was a retrospective study at an academic, urban emergency department (ED) comparing ED and discharge opioid prescribing practices over a 12-week time period for two 14-intern EM classes (2016 and 2018) to evaluate an early opioid reduction education program. The education program included opioid prescribing guidelines for common ED disease states associated with moderate pain, clinician talking points, and electronic education modules, and was completed by EM interns in July/ August 2018. Opioid prescription rates per shift were calculated and opioid prescribing best practices described. We used chi-squared analysis for comparisons between the 2016 and 2018 classes.Results: Overall, ED and discharge opioid orders prescribed by EM interns were fewer in the 2018 class that received education compared with the 2016 class. ED opioid orders were reduced by 64% (800 vs 291 orders, rate per shift 1.8 vs 0.7 orders) and opioid discharge prescriptions by 75% (279 vs 70 prescriptions, rate per shift 0.7 vs 0.2 prescriptions). The rate of prescribing combination opioid products compared to opioids alone was decreased for ED orders (32% vs 16%, P < 0.01) and discharge prescriptions (91% vs 74%, P < 0.01) between the groups. Also, the median tablets per discharge prescription (14.5 vs 10) and total tablets prescribed (4305 vs 749) were reduced, P < 0.01. There were no differences in selection of opioid product or total morphine milligram equivalents prescribed when an opioid was used. Conclusion:An opioid reduction education program targeting EM interns was associated with a reduction in opioid prescribing in the ED and at discharge. This may be an effective way to influence early prescribing patterns and best practices of EM interns.

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“…For example, a 2018 study of how residents would treat pain in four cases provided information only on patient age, surgery, and surgical indication [ 9 ]. Additionally, prior studies have revealed differences in the prescribing patterns of residents dependent on if they are training in surgery or medical specialties [ 10 , 11 ]. In the one qualitative study available of attending and resident surgeon approaches to postoperative pain prescribing, only perspectives about opioid prescribing – and not overall pain assessment and management – were described [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Inpatient pain assessment and decision-making in internal medicine and general surgery residents: A qualitative analysis

Wright,

Polivka,

Villwock

2024

Heliyon

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Pain management and prescribing practices in otolaryngology residency programs

Cited by 6 publications

References 42 publications

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Emergency Medicine Intern Education for Best Practices in Opioid Prescribing

Inpatient pain assessment and decision-making in internal medicine and general surgery residents: A qualitative analysis

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