Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Svider, Peter F.; Nguyen, Brandon; Yuhan, Brian; Zuliani, Giancarlo; Eloy, Jean Anderson; Folbe, Adam J.

doi:10.1002/alr.22107

Cited by 60 publications

(85 citation statements)

References 54 publications

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“…In the aforementioned systematic review by Svider et al, the use of NSAIDS postoperatively had grade A evidence for appropriate pain control. Although there may be a generalized hesitancy associated with use of NSAIDS following FESS, bleeding risk for this population was cited to be 0.8% . Other alternatives for pain control have been proposed as well.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with opioid use after endoscopic sinus surgery

Raikundalia

Cheng

Truong³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Responsible prescribing of postoperative pain medications is necessary in combatting the current opioid epidemic in the United States. The goal of this study was to determine which clinical factors affect opioid usage following functional endoscopic sinus surgery (FESS). Study Design Retrospective medical records study. Methods This is a single‐institution retrospective study of subjects undergoing FESS by the senior author between September 2016 and December 2017. Opioid usage was assessed for each patient at the first postoperative visit. Univariate and multivariable analyses were performed to investigate factors associated with pain medication usage. Patients using opioids prior to surgery were excluded. Results A total of 136 patients were stratified into three groups based on number of opioid tablets taken during the first week after surgery: 31 patients (23%) took no opioids, 61 patients (45%) took one to five tablets, and 44 patients (32%) took more than five tablets. Gender, extent of surgery, revision surgery, polyp status, and cystic fibrosis did not significantly vary between the three groups. Multinomial logistic regression analysis with backward stepwise variable selection method revealed that those who had septoplasty (odds ratio [OR]: 4.84, 95% confidence interval [CI]: 1.68‐13.98; P < .01) or were of younger age (OR 0.96, 95% CI: 0.93‐0.99; P = .01) had significantly higher odds of taking >5 tablets. Conclusions The majority of patients undergoing FESS did not take more than 5 opioid tablets after surgery. Concurrent septoplasty and younger age were associated with increased opioid usage. Knowledge of such factors can help surgeons to assess opioid prescribing patterns and to counsel their patients on postoperative pain.Laryngoscope, 129:1751–1755, 2019

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Section: Discussionmentioning

confidence: 99%

Factors associated with opioid use after endoscopic sinus surgery

Raikundalia

Cheng

Truong³

et al. 2019

The Laryngoscope

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“…The American Society of Anesthesiologists and the American Pain Society recommend using nonopioid analgesics postoperatively, when not contraindicated . Scheduled acetaminophen, as opposed to as‐needed administration, can provide effective pain control and reduce opioid requirements after ESS . In addition, nonsteroidal anti‐inflammatory drugs (NSAIDs) are a safe and effective alternative to opioids for patients without contraindications.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, nonsteroidal anti‐inflammatory drugs (NSAIDs) are a safe and effective alternative to opioids for patients without contraindications. The evidence supporting NSAID use for postoperative analgesia after ESS has an A grade, pursuant to the Grading of Recommendations Assessment, Development and Evaluation approach, and NSAIDs may reduce postoperative opioid consumption . Although many otolaryngologists, particularly in academic medicine, continue to minimize NSAID use due to the theoretical increased risk of bleeding, large cohort studies have failed to demonstrate significant correlation between NSAID use and postoperative bleeding .…”

Section: Discussionmentioning

confidence: 99%

“…For patients with known or suspected contraindications to NSAID use, which include bleeding diatheses, gastrointestinal disease, and allergy, a different strategy will be necessary. Other opioid‐sparing analgesic approaches with supporting evidence include gabapentin, pregabalin, and intraoperative intravenous dexamethasone . Finally, for patients with contraindications to nonopioid analgesics or suspected to have more significant postoperative pain, a short course of opioids may be appropriate.…”

Section: Discussionmentioning

confidence: 99%

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Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

et al. 2018

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Objectives/Hypothesis Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS). Study Design Retrospective chart review. Methods Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription. Results One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039). Conclusions Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices. Level of Evidence 4 Laryngoscope, 129:1046–1052, 2019

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“…Specific to otolaryngology, these procedures, which are predominantly outpatient and associated with only mild‐to‐moderate postoperative pain, represent a high‐impact area where attentive postoperative pain regimens can limit our role in the opioid crisis. Still, there remains no definitive consensus for appropriate postoperative analgesia in sinonasal surgery . In this study we aim to identify factors associated with variable postoperative opioid usage and further define optimal opioid prescription patterns for specific variations and combinations of endoscopic sinus surgery (ESS) and other sinonasal surgeries.…”

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confidence: 99%

Prescription patterns and opioid usage in sinonasal surgery

Newberry

Casazza

Pruitt

et al. 2019

Int Forum Allergy Rhinol

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Background Excess opioid use after surgery contributes to opiate misuse and diversion. Understanding opioid prescribing and utilization patterns after sinonasal surgery is critical in designing effective practice protocols. In this study we aim to identify factors associated with variable opioid usage and further delineate optimal prescription patterns for sinonasal surgery. Methods All patients undergoing sinonasal surgery within a single health‐care system from March 2017 to August 2018 were sent electronic postoperative surveys. Data were collected on the amount of opioid required, pain control, presurgical opiate use, and narcotic disposal. Additional data collected from the electronic medical record included demographics, type of surgery performed, and total amount of opioid prescribed, including refills. Results Three‐hundred sixty four patients were included. A mean number of 25.3 tablets were prescribed per patient, yet the mean taken was just 11.8 tablets. Excess opioids were prescribed 84.9% of the time with a mean excess narcotic in oral morphine equivalents of 152.5. Among patients, 11.8% reported using no opioids, whereas 52.1% used <50% and 36.1% used >50% of their narcotic prescription. Patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery (p > 0.05). The addition of septoplasty and/or turbinoplasty was associated with variation in opioid usage (p < 0.001). A total of 76.1% of patients incorrectly discarded/stored excess opiates. Conclusion Opioids are overprescribed after sinonasal surgery. The amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed. Improved patient education regarding disposal of excess narcotics may help to curtail future opioid diversion.

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Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Cited by 60 publications

References 54 publications

Factors associated with opioid use after endoscopic sinus surgery

Factors associated with opioid use after endoscopic sinus surgery

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

Prescription patterns and opioid usage in sinonasal surgery

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