A Review of Postoperative Pain Management for Thyroid and Parathyroid Surgery

Uhlmann, Rebecca A.; Reinhart, Henry A.; Postevka, Eugene; Snyder, Samuel K.; Arenas, M.

doi:10.1016/j.jss.2019.03.050

Cited by 32 publications

(31 citation statements)

References 21 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%

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%

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

show abstract

“…Nevertheless, patients suffer from quite severe immediate postoperative pain [ 4 ]. Since inappropriate acute pain control could lead to chronic pain and even increased opioid consumption, which is treated as a social problem in extreme cases [ 5 ], clinicians should try to reduce acute postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Randomized Comparison of Postoperative Pain and Complications after Thyroidectomy under Different Anesthetic Techniques: Volatile Anesthesia versus Total Intravenous Anesthesia

Kim

Choi

et al. 2021

Pain Research and Management

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While the postoperative outcome is favorable, post-thyroidectomy pain is considerable. Reducing the postoperative acute pain, therefore, is considered important. This study investigated whether the pain intensity and need for rescue analgesics during the immediate postoperative period after thyroidectomy differ according to the methods of anesthesia. Seventy-two patients undergoing total thyroidectomy under general anesthesia were examined. Patients were randomly assigned to undergo either total intravenous anesthesia with remifentanil and propofol (TIVA, n = 35) or propofol induction and maintenance with desflurane and nitrous oxide (volatile anesthesia [VA], n = 37). The mean administered dose of remifentanil was 1977.7 ± 722.5 μg in the TIVA group, which was approximately 0.268 ± 0.118 μg/min/kg during surgery. Pain scores based on a numeric rating scale (NRS) and the need for rescue analgesics were compared between groups at the postoperative anesthetic care unit (PACU). The immediate postoperative NRS values of the TIVA and VA groups were 5.7 ± 1.7 and 4.7 ± 2.3, respectively ( P = 0.034). Postoperative morphine equianalgesic doses in the PACU were higher in the TIVA group than in the VA group (16.7 ± 3.8 mg vs. 14.1 ± 5.9 mg, P = 0.027). The incidence of immediate postanesthetic complications did not differ significantly between groups. In conclusion, more rescue analgesics were required in the TIVA group than in the VA group to adequately manage postoperative pain while staying in the PACU after thyroidectomy.

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“…For total or subtotal parathyroidectomy, surgical stimulus during the dissection of the gland is mostly gentle, local or regional anesthesia is su cient, and both of the anesthesia can provide postoperative analgesia [5][6][7].However,the conventional anaesthetic technique for parathyroidectomy is total intravenous anesthesia with tracheal intubation and muscle relaxation [8].Additionally,end-stage renal disease affects the metabolism and excretion of opioid analgesics and muscle relaxant,which can defer postoperative recovery [9,10]. Furthermore, Uhlmann et al [6].demonstrated that mild to moderate pain after parathyroidectom may be unsuitable for postoperative recovery programs.A previous study has showed that two-thirds of patients undergoing parathyroidectomy require narcotic analgesics to relieve postoperative pain on the rst day after surgery, while the incidences of postoperative nausea, vomiting, and apnea or respiratory depression also increase [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Bilateral Superficial Cervical Plexus Block Enhance the Quality of Recovery in Patients following Parathyroidectomy with Secondary Hyperparathyroidism

Shu

et al. 2021

Preprint

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Background:Parathyroidectomy has been proposed as method for reduction of PTH levels. We evaluated the effects of ultrasound-guided BSCPB on the quality of recovery following parathyroidectomy with secondary hyperparathyroidism.Methods:Eighty-two patients undergoing parathyroidectomy with secondary hyperparathyroidism were randomly allocated to BSCPB group (ultrasound-guided BSCPB with 7.5ml of ropivacaine 0.5% on each side) and the CON group(normal saline).The primary outcome of QoR-40 score was recorded.Secondary outcomes including total consumption of propofol and remifentanil,the numbers of patient requiring rescue analgesia, the time to first require rescue analgesia, the incidence of PONV, and the VAS scores were recorded.Results:The score in the pain and emotional state dimensions of QoR-40,and total QoR-40 score were higher in the BSCPB group than the CON group on POD1(P=0.000).Compared with the CON group,the total consumption of propofol and remifentanil was significantly decreased in the BSCPB group (P=0.000).Compared with the CON group, the time to first require rescue analgesia was longer(P=0.018),and numbers of patient requiring rescue analgesia were decreased in the BSCPB group ( P=0.000).The incidence of PONV was significantly lower in the BSCPB group than the CON group (P<0.05).The VAS scores in the BSCPB group were lower than the CON group in any time point after surgery (P=0.000). Conclusion: Ultrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV following parathyroidectomy with secondary hyperparathyroidism.Trial registration: ChiCTR1900027185. (Prospective registered). Initial registration date was 04/11/2019.

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A Review of Postoperative Pain Management for Thyroid and Parathyroid Surgery

Cited by 32 publications

References 21 publications

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

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

A Prospective Randomized Comparison of Postoperative Pain and Complications after Thyroidectomy under Different Anesthetic Techniques: Volatile Anesthesia versus Total Intravenous Anesthesia

Ultrasound-Guided Bilateral Superficial Cervical Plexus Block Enhance the Quality of Recovery in Patients following Parathyroidectomy with Secondary Hyperparathyroidism

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