Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society

Gray, Mark H.; Fan, Caleb J.; Kappauf, Catharine; Kidwai, Sarah; Colley, Patrick; Iloreta, Alfred Marc; Govindaraj, Satish

doi:10.1002/alr.22181

Cited by 37 publications

(46 citation statements)

References 25 publications

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“…Opioid prescription behaviors after ESS have not been well characterized in the literature previously. In a recent survey of American Rhinology Society members, 94% of respondents reported prescribing opioids after ESS . Among those surveyed, mean tablets prescribed was greater than compared to our study cohort (27.4 tablets vs. 15.6 tablets) .…”

Section: Discussioncontrasting

confidence: 52%

“…In a recent survey of American Rhinology Society members, 94% of respondents reported prescribing opioids after ESS. 12 Among those surveyed, mean tablets prescribed was greater than compared to our study cohort (27.4 tablets vs. 15.6 tablets). 12 However, there is limited information about variations in prescriber behavior and factors that may influence quantity of opioid prescribed.…”

Section: Discussionmentioning

confidence: 61%

“…Future studies performed in a multi‐institutional and prospective fashion may provide additional data about tailored analgesic requirements. Of note, prior studies have not identified significant differences in the pattern of opioid prescription after ESS between practice settings or geography . Certain limitations of our study should be noted.…”

Section: Discussionmentioning

confidence: 68%

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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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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 68%

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Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

et al. 2018

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“…Despite these findings, the number of narcotics prescribed remains relatively high and inconsistent between providers. A recent survey querying members of the American Rhinology Society revealed that nearly 94% of otolaryngologists prescribed an opioid prescription following FESS . In a study by Arianpour et al using the Centers for Medicare and Medicaid Services database, researchers found that rhinologists on average prescribed 5.4 days of opioids after FESS, with variations depending on surgeon age, experience, and demographics .…”

Section: Introductionmentioning

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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“…Additionally, the pain may increase cardiac and pulmonary complications and even lead to death (Gerbershagen et al, 2013;Pöpping et al, 2008). Furthermore, postoperative pain can increase healthcare costs and reduce work productivity (Gray et al, 2018). Although laparoscopy has been widely used in gynaecological surgery, resulting in a smaller incision and less postoperative pain (Gray et al, 2018), pain after laparoscopic gynaecological surgery still remains a problem (Kehlet, 2018).…”

Section: Introductionmentioning

confidence: 99%

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

Yang

Xiong

Xia

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway. Background Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery. Design Comparative cross‐sectional study. Methods A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11‐point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study. Results The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214–0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164–0.255. Conclusions The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment. Relevance to clinical practice Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self‐reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

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Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society

Cited by 37 publications

References 25 publications

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

Factors associated with opioid use after endoscopic sinus surgery

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

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