Pain Management Following Otological Surgery: A Prospective Study of Different Strategies

Dahm, Valerie; Lui, Justin T.; Chen, Joseph M.; Kiss, Alex; Hamour, Amr F.; Le, Trung; Lin, Vincent

doi:10.1002/lary.29845

Cited by 4 publications

(11 citation statements)

References 24 publications

(58 reference statements)

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“…43,44 A systemic review by Campbell et al 44 found that 21% of studies reported reduced postoperative pain scores in otology patients when more than one analgesic was used, with acetaminophen having the fewest adverse effects and NSAIDs and multimodal analgesia having the greatest pain control. Similarly, a prospective nonrandomized cohort study by Dahm et al 34 found no differences in pain scores between patients who were prescribed acetaminophen and ibuprofen and those who were prescribed acetaminophen and codeine. This study presents the first prospective, randomized controlled study comparing multimodal analgesia to opioid monotherapy in otology.…”

Section: Discussionmentioning

confidence: 92%

“…These data underscore the risk that opioid over prescription directly poses to patients. Additionally, Dahm et al 34 reported that over 90% of patients kept extra opioids in their home. 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.…”

Section: Discussionmentioning

confidence: 99%

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Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Butkus

Awosanya

Scott

et al. 2023

Otolaryngol.--head neck surg.

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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.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Butkus

Awosanya

Scott

et al. 2023

Otolaryngol.--head neck surg.

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“…A word of caution: there are several recent reports on excessive opioid prescription practices after otologic operations (20)(21)(22), with recommendations that these drugs be avoided because of their association with chronic pain disorder and substance abuse. It had been suggested (23) and demonstrated (24) that routine opioid prescription after middle ear surgery can be avoided without a resultant pain-control compromise.…”

Section: Control Of Postoperative Painmentioning

confidence: 99%

Preoperative Anxiety Levels and Postoperative Middle Ear Surgery Pain Levels

et al. 2023

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ObjectiveThis study aimed to characterize self-reported postoperative pain after tympanoplasty and tympanomastoidectomy and correlate pain severity with the patient's preoperative anxiety state.Study DesignProspective cohort study.SettingTertiary referral medical center.PatientsAdult patients undergoing any middle ear surgery between July 2018 and July 2019.Main Outcome MeasuresPatient responses to an otology questionnaire (OQ) for scoring pain intensity on a visual analog scale preoperatively and on postoperative days (PODs) 1–4, 21, and 63. The responses were correlated with anxiety state (assessed by State-Trait Personality Inventory [STPI] scores) and clinical and operative data, including surgical technique–related details.ResultsSixty patients were enrolled (mean age ± standard deviation, 40 ± 19.7 yr, 26 men). Their median preoperative (baseline) visual analog scale pain score was 6 on POD1, 5 on POD3, and 1 at 3 and 7 weeks. Their median preoperative OQ score was 32 of 70 (45.7%), 37 of 70 (52.8%) on POD1, 33 of 70 (47.1%) on POD3, 6 of 70 (8.5%) at 3 weeks, and 6 of 70 at 7 weeks. Their overall mean preoperative anxiety level (STPI score) was 2.63 ± 1.50. STPI scores were significantly higher among patients who reported OQ scores equal to or higher than the median during PODs 1 to 4 in comparison to patients who reported OQ scores lower than the median. The α Cronbach correlation between anxiety and postoperative pain scores on POD1 was 0.97.ConclusionPreoperative anxiety levels are closely associated with postoperative pain levels after any middle ear surgery. Measures to control preoperative anxiety are warranted to alleviate postoperative pain.

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“…Numerous studies have described over‐prescription rates in surgery broadly and Otolaryngology—Head and Neck Surgery (OHNS) specifically 6–9 . A previous study from our center found that 78.5% of patients undergoing an OHNS procedure were left with unused opioids following their postoperative course 10 .…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have described over-prescription rates in surgery broadly and Otolaryngology-Head and Neck Surgery (OHNS) specifically. [6][7][8][9] A previous study from our center found that 78.5% of patients undergoing an OHNS procedure were left with unused opioids following their postoperative course. 10 More than half of these patients kept their unused narcotics at home for future use, a known risk factor for opioid diversion and misuse.…”

Section: Introductionmentioning

confidence: 99%

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Hamour

Manojlovic-Kolarski

Eskander

et al. 2023

Laryngoscope Investig Oto

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Background: Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia. Methods: Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans. Results: A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling (n = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, p < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, p < .05). Patients who received local anesthesia peri-operatively (46.4%, n = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), p < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), p < .05]. Conclusion: Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction.

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Pain Management Following Otological Surgery: A Prospective Study of Different Strategies

Cited by 4 publications

References 24 publications

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Preoperative Anxiety Levels and Postoperative Middle Ear Surgery Pain Levels

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

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