Postoperative Opioid Use in Sinonasal Surgery

Abstract

Objective To survey patients following sinonasal surgery regarding postoperative pain and opioid use. Study Design Patients were surveyed for 4 days following sinus and/or nasal surgery regarding their pain level and use of prescribed opioids. Setting Four academic medical centers and 1 private practice institution. Subjects Consecutive adult patients undergoing sinonasal surgery. Results A total of 219 subjects met criteria and were included for analysis; 134 patients (61%) took 5 or fewer combination oxycodone (5-mg) and acetaminophen (325-mg) tablets in the first 3 postoperative days, and 196 patients (89.5%) took fewer than 15. Fifty-one patients (23%) consumed no opioid pain medication. Opioid consumption was positively correlated with postoperative pain (R2 = 0.2, P < .01) but was not correlated with the use of acetaminophen (R2 = 0.002, P = .48). No significant difference in postoperative pain or opioid consumption was seen with respect to age, sex, specific procedures performed, postoperative steroids, or smoking history. Current smokers reported higher average pain than nonsmokers (P < .001) and also required more postoperative opioids (P = .02). Conclusions An evidence-based approach to postoperative pain control following sinonasal surgery that reduces the number of unused and potentially diverted opioids is needed. The current study suggests that 15 combination oxycodone (5-mg) and acetaminophen (325-mg) tablets provide sufficient pain control for 90% of patients in the immediate postoperative period following sinonasal surgery, irrespective of the specific procedures performed, use of acetaminophen, or use of systemic steroids. Smoking status may help surgeons predict which patients will require larger opioid prescriptions.

Objective Quantification of Opioid Usage After Thyroid Surgery

“…A common trend amongst published literature regarding the amount of opioid pain medication prescribed postoperatively is a reduction in the amount of opioid medication prescribed after analyzing patient consumption. [6][7][8][9][10]13,14 We, likewise, found this to be true for our practice.…”

Prescription patterns and opioid usage in sinonasal surgery

“…Surgeons often prescribe opioid medications based on training and routine rather than evidence‐based medicine . Previous investigations have shown that this can result in excess opioids being prescribed . As the current opioid crisis persists, conscientious, evidence‐based postoperative prescribing is imperative to limit our role in opioid diversion and potential dependence.…”

“…Recently, more light has been shed on physicians’ role in the opioid crisis . In particular, as persistent opioid use after any surgery is nearing 10%, irrespective of the procedure's complexity, conscientious postoperative prescribing has become a point of interest . Nevertheless, the surgeon's unintended role spans further than their own patients as a significant portion of abused opioids stems from diversion, often obtained from friends or family who have excess unused pills …”

“…3 In particular, as persistent opioid use after any surgery is nearing 10%, irrespective of the procedure's complexity, conscientious postoperative prescribing has become a point of interest. 4,5 Nevertheless, the surgeon's unintended role spans further than their own patients as a significant portion of abused opioids stems from diversion, often obtained from friends or family who have excess unused pills. [6][7][8] To limit the surgeon's inadvertent effects in the opioid crisis, conservative postoperative analgesia after ambulatory surgery has been advocated as an area of improvement; however, aggressive immediate postoperative analgesia is thought to reduce subsequent analgesic requirements, alleviate anxiety, and improve patient satisfaction.…”

“…8 Sinonasal surgical procedures are among the most common operations performed in otolaryngology, with over 260,000 septoplasties and 250,000 of these performed annually. 5 Specific to otolaryngology, these procedures, which are predominantly outpatient and associated with only mild-to-moderate postoperative pain, represent a highimpact 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.…”