Prescription opioids are commonly unused after ambulatory head and neck surgeries: Opioids prescription presence and size has no effect on patient satisfaction with pain control

Elsharydah, Ahmad; Karani, Sadia Y.; Pothini, Tanushri; Truong, Kevin H.; Shu, David J.; Ruikar, Kinnari V.; Huynh, Tinh T; Tran, Coby

doi:10.1016/j.amjoto.2021.103093

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…Several studies suggest that many ambulatory surgeries can be managed without opioids and that otologic surgeries confer mild postoperative pain 28,38,39 . To date, many of the studies investigating alternative therapies in otology have been retrospective or have been analyzed along with other ambulatory surgeries 40,41 . These studies demonstrated promising data that the majority of otologic surgery can be managed with over the counter medications without compromising patient satisfaction, but comprehensive study of effective alternatives is needed.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Butkus

Awosanya

Scott

et al. 2023

Otolaryngol.--head neck surg.

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Objective This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. Study Design Prospective cohort study. Setting Single tertiary‐care facility. Methods Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. Results Eighty‐six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). Conclusion The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.

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Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Butkus

Awosanya

Scott

et al. 2023

Otolaryngol.--head neck surg.

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“…In the context of recent literature, this highlights the risk that opioid over‐prescription poses on communities and underscores the importance of alternative pain management. Numerous studies in otolaryngology suggest that many ambulatory surgeries can be managed with no minimal opioids and multimodal analgesia without compromising patient satisfaction 24‐44 . Additionally, multimodal analgesia has demonstrated superior pain control than monotherapies in the postoperative setting 15,24,31 .…”

Section: Discussionmentioning

confidence: 99%

“…For instance, the American Academy of Otolaryngology–Head and Neck Surgery released opioid prescribing guidelines in 2021 that recommend risk factor screening for opioid use disorder, nonopioid pain medications as first‐line treatment, and counseling about safe opioid storage and disposal for common otolaryngological surgeries 5 . Additionally, the validation of alternative pain management strategies, such as multimodal analgesia with opioids, acetaminophen, and/or NSAIDs, supports the feasibility of reducing reliance on opioid monotherapy for postoperative pain management 24‐44 . Corticosteroids present an additional drug class that clinicians can leverage to improve postoperative morbidity.…”

mentioning

confidence: 99%

Prednisone Decreases Opioid Use in Adults Undergoing Benign Oropharyngeal Surgery

Butkus,

Sagalow,

Alfonsi

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThis study sought to analyze the efficacy and safety of postoperative prednisone to reduce reliance on opioids in adult benign oropharyngeal surgery.Study DesignProspective cohort study.SettingSingle tertiary‐care facility.MethodsPatients undergoing tonsillectomy (T), tonsillectomy and adenoidectomy (T&A), and/or modified uvulopalatopharyngoplasty (UPPP) from December 2020 to January 2023 received the standard of care postoperative management. A prednisone taper was dependent on surgeon preference. Cohorts were based on the prescription of postoperative steroids. Patients completed a survey to assess opioid usage, pain scores, and steroid compliance.ResultsSeventy‐two patients were included. The nonsteroid cohort (N = 29) received an average of 467 ± 94.1 morphine milligram equivalents (MME), and the steroid cohort (N = 43) received an average of 285 ± 128 MME (P < 0.001). The nonsteroid cohort consumed 1.62 times more opioids than the steroid cohort (P < 0.002). There were no significant differences in complication or refill rates between treatment groups. There were no significant differences in pain scores on the day of surgery or postoperative days 1, 5, or 10 (P = 0.34, P = 0.66, P = 0.62, and P = 0.22, respectively). Patients undergoing T&A (p = 0.019) or who had current psychiatric medication use (P < 0.006) consumed significantly more opioids. Patients who received a total opioid prescription of >300 MME (40 5‐mL doses of 5 mg/5 mL liquid oxycodone) consumed 2.27 times more postoperative opioids than patients with opioid prescriptions ≤300 MME (P < 0.001).ConclusionPatients who did not receive steroids consumed 1.62 times more postoperative opioids compared to those who completed a steroid taper. Corticosteroid use was not associated with changes in pain scores, refill rates, or complication rates and may be considered in a multimodal approach to pain management in adults undergoing benign oropharyngeal surgery, although further study is warranted.

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“…Patient satisfaction with pain control has been thought to be determined by the amount of opioid medication prescribed, a belief that has contributed to generous prescribing habits . However, recent studies in the head and neck surgical literature have demonstrated that patient satisfaction with care and postoperative pain control is not associated with the amount of opioids prescribed …”

Section: Introductionmentioning

confidence: 99%

“…2 However, recent studies in the head and neck surgical literature have demonstrated that patient satisfaction with care and postoperative pain control is not associated with the amount of opioids prescribed. 3,4 Numerous studies have examined current practices in otolaryngology with respect to different subsets of procedures to provide an evidence-based approach to decreasing the number of opioid prescriptions. The clinical practice guideline published in April 2021 by the American Academy of Otolaryngology−Head and Neck Surgery 5 provides detailed recommendations for safely prescribing opioids for common otolaryngologic procedures.…”

mentioning

confidence: 99%

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

March

Lim

Manzione

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPrescribing practices for opioid medication after thyroid surgery have been well-studied and established; however, the need for pain management with opioid medication following lateral neck dissection for malignant thyroid disease with a short hospital stay has not been established. OBJECTIVE To evaluate a multimodal opioid reduction intervention and its association with a decrease in prescribing of opioid medication at hospital discharge for patients after a lateral neck dissection for thyroid cancer. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective cohort study of patients treated from 2011 to 2021 by a tertiary academic institution that performs a high volume of thyroid cancer surgeries annually. We evaluated the electronic health records of 417 patients who had undergone lateral neck dissection for malignant thyroid disease from June 1, 2011, to June 30, 2021, and had a short hospital stay (Յ3 days). Patients with longer stays (>3 days) or additional surgical procedures were excluded. Group 1 comprised patients who underwent a neck dissection before the intervention; and group 2, those who underwent the procedure after implementation of the intervention.INTERVENTION A multimodal intervention composed of 3 components to reduce opioid prescribing at hospital discharge home after neck dissection for malignant thyroid disease with a short hospital stay. MAIN OUTCOMES AND MEASURESThe primary outcome was the quantity of opioid medication prescribed in the postoperative period, measured as oral morphine milliequivalents (MME). The eta-squared effect size (η 2 ES) metric was used to determine the association of the intervention with a reduction in the MME quantities of opioid medication administered to inpatients and prescribed at discharge. An estimated need for opioids was established for the average patient undergoing lateral neck dissection for thyroid cancer based on the upper range of prescribing after intervention. The data were analyzed from January to March 2022. RESULTSThe total study population was 417 patients: group 1 with 171 patients (mean [SD] age , 47.1 [15.6] years; 104 [61%] women; 144 [84%] non-Hispanic White) and group 2 with 246 patients (mean [SD] age , 46.2 [17.4] years; 146 [60%] women; 206 [83.7%]non-Hispanic White). The median MME prescribed at discharge for group 1 per patient was 225 MME compared with 0 MME for group 2, a large effect-size difference. There was a moderate association between the dose amount administered to an inpatient and the prescription dose they received at discharge (r, 0.33). Multiple linear regression analysis of sex, age, race and ethnicity, extent of surgery, and opioid reduction intervention showed that the intervention had a large clinically meaningful association with decreasing opioid prescriptions and dosage amounts at discharge (η 2 ES, 0.26; 95% CI, 0.19-0.33). CONCLUSIONS AND RELEVANCEThe findings of this retrospective cohort study suggest that patients undergoing lateral neck dissections for thyroid cancer with short hospitalization ...

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Prescription opioids are commonly unused after ambulatory head and neck surgeries: Opioids prescription presence and size has no effect on patient satisfaction with pain control

Cited by 4 publications

References 26 publications

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Prednisone Decreases Opioid Use in Adults Undergoing Benign Oropharyngeal Surgery

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

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