A randomized controlled trial of corticosteroids for pain after transoral robotic surgery

Clayburgh, Daniel; Stott, Will; Bolognone, Rachel K.; Palmer, Andrew D.; Achim, Virginie; Troob, Scott H.; Li, Ryan; Brickman, Daniel; Graville, Donna J.; Andersen, Peter E.; Gross, Neil D.

doi:10.1002/lary.26625

Cited by 27 publications

(30 citation statements)

References 23 publications

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“…We suspect this is due to their use of multimodal analgesia, including steroids . Steroids have been reported to reduce VAS pain scores and length of stay . Slama et al also investigated TORS for oral cancer and reported an average VAS of 5.1 for week 1, similar to our findings .…”

Section: Discussionsupporting

confidence: 86%

“…13 Steroids have been reported to reduce VAS pain scores and length of stay. 14 Slama et al also investigated TORS for oral cancer and reported an average VAS of 5.1 for week 1, similar to our findings. 15 Thiels et al reported a median prescription of 350 MME and use of 180 MME in TORS tonsillectomies (49% unused) compared to our mean prescription of 368 MME and use of 221 MME (40% unused).…”

Section: Predictors Of Opioid Usesupporting

confidence: 90%

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Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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Objectives In otolaryngology, postoperative pain management lacks evidence‐based guidelines. We designed a prospective, multiphasic study aimed to develop evidence‐based guidelines for postoperative pain management within our institution. In this first phase of our project, we investigated opioid prescription and consumption as well as pain trends for common otolaryngologic procedures. Methods Patients (n = 161) who underwent procedures between July 2018 and February 2019 were surveyed on their postoperative opioid usage and pain from day of discharge to first clinic visit. Opioid prescriptions were converted to standardized units of morphine milligram equivalents (MME). The procedures selected for analysis were parathyroidectomy/thyroidectomy, parotidectomy, sialendoscopy, and transoral robotic surgery resection (TORS). Results In total, 19,748 MME were prescribed: 8,588 MME (43.5%) were used, leaving 11,159 MME (56.5%) unused. TORS average MME used: 221 ± 227; total MME unused: 38%. Sialendoscopy average MME used: 31 ± 46; total MME unused: 67%. Parathyroidectomy/thyroidectomy average MME used: 30 ± 37; total MME unused: 66%. Parotidectomy average MME used: 43 ± 53; total MME unused: 65%. Male gender, smoking (current and former), and psychiatric medication use were positive predictors of opioid consumption in postoperative patients (P < 0.001). Conclusion At our institution, over 50% of prescribed postoperative opioids went unused. This was most pronounced for nonmucosal surgeries. Postoperative pain management should account for this to minimize unnecessary opioid prescriptions. Based on our findings and review of current literature, we are in the process of developing prescribing recommendations to be implemented within our institution. Level of Evidence 2 Laryngoscope, 130:659–665, 2020

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Section: Discussionsupporting

confidence: 86%

Section: Predictors Of Opioid Usesupporting

confidence: 90%

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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“…A 2013 systematic review of pain control strategies for HNC pain found that there was insufficient evidence from randomized controlled studies to suggest the optimal pharmacological intervention 31 . Since the time of that publication, randomized controlled trials have been published examining the efficacy of gabapentin, 32 celcoxib, 33 and corticosteroids 34 as adjuncts for pain control. These studies demonstrated no significant efficacy in reducing pain related to oral mucositis with gabapentin 32 or celcoxib 33 but did demonstrate some improvement with postoperative pain after transoral robotic surgery with corticosteroid 34 administration.…”

Section: Discussionmentioning

confidence: 99%

Chronic opioid use after laryngeal cancer treatment

et al. 2020

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Background: Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors. Methods: Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment. Results: In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use. Conclusions: Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.

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“…[23][24][25][26][27] In the present study, patients receiving dexamethasone also reported less pain and needed less oxycodone for 5 postoperative days. A study by Clayburgh et al 28 showed that extended perioperative corticosteroid use after transoral robotic surgery for initial treatment of oropharyngeal squamous cell carcinoma decreased the length of hospital stay, although postoperative pain was minimally affected. The present trial is the first prospective randomized study to evaluate the perioperative use of dexamethasone in patients with head and neck cancer and microvascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Kainulainen

Lassus

Suominen

et al. 2018

Journal of Oral and Maxillofacial Surgery

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A randomized controlled trial of corticosteroids for pain after transoral robotic surgery

Abstract: 1b. Laryngoscope, 127:2558-2564, 2017.

Cited by 27 publications

References 23 publications

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Chronic opioid use after laryngeal cancer treatment

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

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