Postoperative Pain Management in Dermatologic Surgery

Saco, Michael; Golda, Nicholas

doi:10.1016/j.det.2019.03.004

Cited by 11 publications

(34 citation statements)

References 14 publications

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“…Anesthesiology and pain management specialty guidelines consistently recommend a multimodal pain regimen that may include local anesthetics injected into the surgical site, regional blockade, acetaminophen, NSAIDs, and gabapentin, while reserving opioids for pain not adequately controlled with the initial regimen. 16,113-132…”

Section: Key Action Statementsmentioning

confidence: 99%

“…The purpose of this statement is to encourage the clinician to preferentially recommend nonopioid medications, such as acetaminophen and/or NSAIDs, as first‐line pain management for most otolaryngologic procedures. Anesthesiology and pain management specialty guidelines consistently recommend a multimodal pain regimen that may include local anesthetics injected into the surgical site, regional blockade, acetaminophen, NSAIDs, and gabapentin, while reserving opioids for pain not adequately controlled with the initial regimen 16,113–132 …”

Section: Key Action Statementsmentioning

confidence: 99%

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Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

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Objective Opioid use disorder (OUD), which includes the morbidity of dependence and mortality of overdose, has reached epidemic proportions in the United States. Overprescription of opioids can lead to chronic use and misuse, and unused narcotics after surgery can lead to their diversion. Research supports that most patients do not take all the prescribed opioids after surgery and that surgeons are the second largest prescribers of opioids in the United States. The introduction of opioids in those with OUD often begins with prescription opioids. Reducing the number of extra opioids available after surgery through smaller prescriptions, safe storage, and disposal should reduce the risk of opioid use disorder in otolaryngology patients and their families. Purpose The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. Employing these action statements should reduce the variation in care across the specialty and improve postoperative pain control while reducing risk of OUD. The target patients for the guideline are any patients treated for anticipated or reported pain within the first 30 days after undergoing common otolaryngologic procedures. The target audience of the guideline is otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures. Outcomes to be considered include whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan. The guideline addresses assessment of the patient for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and the responsible use of opioids. Last, safe disposal of unused opioids is discussed. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not a comprehensive guide on pain management in otolaryngologic procedures. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experiences and assessments of individual patients. Action Statements The guideline development group made strong recommendations for the following key action statements: (3A) prior to surgery, clinicians should identify risk factors for opioid use disorder when analgesia using opioids is anticipated; (6) clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery; (9) clinicians should recommend that patients (or their caregivers) store prescribed opioids securely and dispose of unused opioids through take-back programs or another accepted method. The guideline development group made recommendations for the following key action statements: (1) prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain; (2) prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain; (3B) in patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan; (4) clinicians should promote shared decision making by informing patients of the benefits and risks of postoperative pain treatments that include nonopioid analgesics, opioid analgesics, and nonpharmacologic interventions; (5) clinicians should develop a multimodal treatment plan for managing postoperative pain; (7) when treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration; (8A) clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur; (8B) clinicians should educate patients to stop opioids when pain is controlled with nonopioids and stop all analgesics when pain has resolved; (10) clinicians should inquire, within 30 days of surgery, whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan.

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Section: Key Action Statementsmentioning

confidence: 99%

Section: Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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“…Primarily, non-opioid analgesics such as paracetamol, ibuprofen, or novamine sulfone may be considered as postoperative analgesics. 25,26 None of the patients in this study required the use of opioids postoperatively. The aesthetic result was judged by physicians to be very good or good in 94.6% of patients at discharge, but only in 73% of patients after 4 weeks.…”

Section: Discussionmentioning

confidence: 92%

Modification of Skin Flaps for Single-Stage Reconstruction of the Nasal Ala Using All-Layer Suture: A Prospective Study

et al. 2022

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Background and Objectives After local flaps, it may be necessary to reconstruct the contour of the nasal ala. This is possible with a single-stage all-layer shaping suture. In the present study, the functional and aesthetic results after single-stage reconstruction of the nasal ala were prospectively evaluated. Patients and methods Patients who underwent surgery for skin tumors of the nose between 06/2019 and 06/2020 who required reconstruction of the nasal ala as part of the defect closure and had an all-layer suture used were prospectively included in the study. A standardized evaluation of aesthetic and functional outcome was conducted by the patient and a physician at discharge as well as 4 weeks later. Patients additionally underwent a follow-up survey 6 months later. Results Thirty-seven patients were included in the study. Four weeks postoperatively, all flaps were found to be fully healed and vital. Aesthetic outcome at 4 weeks was rated as very good or good by physicians in 73% and by patients in 78.4%. Persistent complications due to reduced blood flow were not observed. Conclusion The reshaping of the nasal ala as part of the defect reconstruction with an all-layer suture demonstrates very good aesthetic as well as functional results and can be performed in a single-stage procedure.

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“…Risk factors for increased pain may include flap or graft repair, location on the scalp, lip, nose, or ear, defect size $3 cm, repair size $10 cm 2 , younger patient age, and increased number of lesions treated. 2,4,5,18 The reconstructions included in this study were those identified to cause pain significant enough to warrant narcotic analgesia by the opioid prescribing guidelines of the American Academy of Dermatology. 7 Several interesting patterns were observed.…”

Section: Discussionmentioning

confidence: 99%

“…Although narcotic use in the first 24 hours and 48 hours overall was lower in the bupivacaine group, during the second 24 hours, there was only a trend toward reduction ( p = .083). Because pain is highest in the first 24 hours postoperatively, 2,3 the lack of significance in the second 24 hours may be explained by overall lower use of narcotics in both groups during this period and the waning effect of bupivacaine over time.…”

Section: Discussionmentioning

confidence: 99%

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Voss

Veerabagu

et al. 2022

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BACKGROUND Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS). OBJECTIVE Evaluate how bupivacaine affects postoperative pain and narcotic use. MATERIALS AND METHODS In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0–10), and whether pain was controlled. RESULTS One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08–4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91–5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28–5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73–2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred. CONCLUSION Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.

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Postoperative Pain Management in Dermatologic Surgery

Cited by 11 publications

References 14 publications

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Modification of Skin Flaps for Single-Stage Reconstruction of the Nasal Ala Using All-Layer Suture: A Prospective Study

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

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