Perioperative pain management and opioid‐reduction in head and neck endocrine surgery: An American Head and Neck Society Endocrine Surgery Section consensus statement

Ferrell, Jay K.; Shindo, Maisie L.; Stack, Brendan C.; Angelos, Peter; Bloom, Gary; Chen, Amy Y.; Davies, Louise; Irish, Jonathan C.; Kroeker, Teresa R.; McCammon, Susan; Meltzer, Charles; Orloff, Lisa A.; Panwar, Aru; Shin, Jennifer J.; Sinclair, Catherine F.; Singer, Michael C.; Wang, Tiffany V.; Randolph, Gregory W.

doi:10.1002/hed.26774

Cited by 14 publications

(13 citation statements)

References 77 publications

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“… 29–31 This shift was further supported by the Endocrine Surgery Section of the American Head and Neck Society (AHNS-ES), whereas a consensus statement on perioperative pain management and opioid reduction in head and neck endocrine surgery was recently released from AHNS-ES. 17 They indicate that non-opioid medications and adjunctive strategies can effectively manage pain after head and neck or endocrine procedures and reduce postoperative opioid requirements. …”

Section: Discussionmentioning

confidence: 99%

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Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study

Alzahrani¹

2023

IJGM

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Background Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons. Methods This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient’s discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. Results An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only. Conclusion The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

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Section: Discussionmentioning

confidence: 99%

“… 4 , 16 Combination of paracetamol, ibuprofen, and tramadol is an example of a multi-modality postoperative pain management regimen. 17 …”

Section: Introductionmentioning

confidence: 99%

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study

Alzahrani¹

2023

IJGM

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“…This shift toward non-opioid analgesics was further supported by the Endocrine Surgery Section of the American Head and Neck Society (AHNS-ES), whereas a consensus statement on perioperative pain management and opioid reduction in head and neck endocrine surgery was recently released from AHNS-ES (17). They indicate that "non-opioid medications and adjunctive strategies can effectively manage pain after head and neck or endocrine procedures and reduce postoperative opioid requirements."…”

Section: Discussionmentioning

confidence: 99%

“…Shifting to multimodal pain control methods was incorporated to improve the postoperative analgesia quality and minimize opioid use (4,16). Combination of paracetamol, ibuprofen, and tramadol are example of a multi-modality postoperative pain management regimen (17).…”

Section: Introductionmentioning

confidence: 99%

Usage patterns of postoperative pain control medication after thyroidectomy: A retrospective cohort study

Alzahrani

2022

Preprint

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Background Thyroid surgery is one of the most common surgical procedures with typical mild-to-moderate pain postoperatively. Thus, postoperative pain control is clearly of primary concern to patients, as well as surgeons. The unnecessary use of opioid analgesics is a well-known contributing factor to opioid addiction. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus to limit the use of opioid medications as the first-line pain medications after head and neck or endocrine procedures. Thus, this study aimed to evaluate the postoperative pain control medication prescription practices of head and neck or endocrine surgeons for patients who underwent thyroid surgery. Methods This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient’s discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. Results An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients whereas 43 (41%) were discharged on paracetamol only. Conclusions The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

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“…At present, multimodal analgesia based on nerve block is being widely investigated and has produced encouraging clinical results. 7 The invasive sites of breast endoscopic thyroidectomy are mainly the anterior chest wall and neck, which are innervated by the intercostal and cervical plexus nerves, respectively. For the analgesia used in this type of surgery, limited studies have been conducted on analgesia in the neck region, whereas no relevant reports have been regarding analgesia in the chest region.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study

Zhong¹,

Zou²,

Bao³

et al. 2023

JPR

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Purpose This study aimed to investigate the analgesic effect of ultrasound-guided transversus thoracis plane block (TTPB) combined with intermediate cervical plexus block (ICPB) in the early postoperative period after trans-areolar endoscopic thyroidectomy. Patients and Methods A total of 62 female patients undergoing trans-areolar endoscopic thyroidectomy were randomly classified to the TTPB combined with ICPB group with ropivacaine (block group) or superficial cervical plexus block group (control group). The primary outcome measures were resting visual analogue scale (VAS) in the chest area at 6 h after surgery. The secondary outcome measures included chest resting and movement VAS score, neck resting and movement VAS score within 24 h after surgery, intraoperative remifentanil consumption, postoperative analgesia rate and analgesic requirements and patient satisfaction score for pain management at discharge. Results Compared with the control group, the block group at rest showed consistently lower VAS scores in the chest area at 6 and 12 h after operation; the block group at rest showed lower VAS scores in the neck at 6, 12 and 24 h after operation. Regarding movement, the VAS scores of the chest and neck area at 2, 6, 12 and 24 h after the operation were lower in the block group than in the control group. The consumption of remifentanil, rate of postoperative analgesic requirements, and consumption of postoperative rescue analgesia in the block group were lower than those in the control group. Satisfaction with pain treatment at discharge was higher in the block group than in the control group. Conclusion Ultrasound-guided TTPB combined with ICPB provides good analgesic effect in the early postoperative period after trans-areola endoscopic thyroidectomy.

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Perioperative pain management and opioid‐reduction in head and neck endocrine surgery: An American Head and Neck Society Endocrine Surgery Section consensus statement

Cited by 14 publications

References 77 publications

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study

Usage patterns of postoperative pain control medication after thyroidectomy: A retrospective cohort study

Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study

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