Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Abstract

Background: Opioid-based analgesics are routinely prescribed a er elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach.Methods: Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing a itudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0-100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2-week period. Results:Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills a er surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills le over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0-94) on day 0, 26.5 (range, 0-86) on day 1, 8.5 (range, 0-85) on day 3, and 3 (range, 0-52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively. Conclusion:Postoperative pain a er elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly a erward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication a er rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse. C 2018 ARS-AAOA, LLC. How to Cite thisArticle: Riley CA, Kim M, Sclafani AP, et al. Opioid analgesic use and patient-reported pain outcomes a er rhinologic surgery. Int Forum Allergy Rhinol. 2019;9:339-344.

Prescription patterns and opioid usage in sinonasal surgery

“…Similar to other recent studies, our patients who underwent ESS had increased opioid consumption when a concurrent septoplasty and/or turbinoplasty was performed, and, comparable to work by Riley et al and Raikundalia et al, the extent of ESS (full vs limited) did not significantly influence pain control or opioid use . Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more . However, as in our study with a very mild negative correlation with increasing age and other studies showing no correlation between age and opioid use, the clinical significance of this is not likely drastic .…”

“…Nevertheless, there is much to gain by looking at the similarities and differences in those studies. Similar to other recent studies, our patients who underwent ESS had increased opioid consumption when a concurrent septoplasty and/or turbinoplasty was performed, and, comparable to work by Riley et al and Raikundalia et al, the extent of ESS (full vs limited) did not significantly influence pain control or opioid use . Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more .…”

“…12,[22][23][24] Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more. 12,22,23 However, as in our study with a very mild negative correlation with increasing age and other studies showing no correlation between age and opioid use, the clinical significance of this is not likely drastic. 7,12,22,24 Furthermore, although Jafari et al showed that preoperative opioid use was associated with additional opioid use, our study and multiple others showed that chronic pain patients will not require a significant amount more than other patients.…”

“…However, a wide range of methods, statistical analyses, and patient populations were utilized in those studies. Some of the studies looked at categorical use of opioids (no tablets used vs more than one tablet used, refills vs none); others assessed smaller cohort sizes, which could have potentially missed significant differences, or heterogeneous groups, where, for example, patients who underwent septoplasty with turbinoplasty and those who underwent septoplasty without turbinoplasty were included in the same group . Nevertheless, there is much to gain by looking at the similarities and differences in those studies.…”

“…Some of the studies looked at categorical use of opioids (no tablets used vs more than one tablet used, refills vs none); others assessed smaller cohort sizes, which could have potentially missed significant differences, or heterogeneous groups, where, for example, patients who underwent septoplasty with turbinoplasty and those who underwent septoplasty without turbinoplasty were included in the same group. 12,16,21,22 Nevertheless, there is much to gain by looking at the similarities and differences in those studies. Similar to other recent studies, our patients who underwent ESS had increased opioid consumption when a concurrent septoplasty and/or turbinoplasty was performed, and, comparable to work by Riley et al and Raikundalia et al, the extent of ESS (full vs limited) did not significantly influence pain control or opioid use.…”