Opioid Use After Orbital, Eyelid, or Lacrimal Surgery

Abstract

Purpose: Opioids may be indicated to mitigate pain after oculofacial surgery. The opioid crisis prompted attention to how these medications are dispensed and disposed. This study aims to characterize opioid usage and handling of patients undergoing oculofacial plastic surgery. Methods: Eighty-nine adult patients were surveyed on their opioid usage after undergoing orbital, lacrimal, or eyelid (including esthetic) surgery at a tertiary oculofacial plastic surgery practice. Each patient was prescribed 10 tablets of hydrocodone/acetaminophen 5 mg/325 mg; one tablet taken orally as needed every 6 hours for pain not relieved by acetaminophen. Subset analysis was performed for type of surgery, age, and gender. Results: Patients consumed an average of 3 ± 0.4 tablets. In the subsets, the averages were 2.1 ± 0.5 (n = 38) tablets after eyelid surgery, 1.6 ± 0.6 (n = 24) after lacrimal surgery, and 5.6 ± 0.9 (n = 27) after orbital surgery. Greater opioid usage was observed after orbital versus eyelid surgery (p = 0.0007) and orbital versus lacrimal surgery (p = 0.0005) but not eyelid versus lacrimal surgery (p = 0.8604). Forty-six patients (51.7%) used no opioids. Over half (57.3%; n = 51) filled their prescription. Thirty-three patients (37.1%) had unused medications, of which 21 patients did not properly dispose of their medications. The mean age of patients who used opioids was less than the mean age of those who needed no opioids (p = 0.024). There were no gender differences in opioid usage use versus not (p = 0.62). Conclusions: Opioid needs after oculofacial plastic surgeries, especially eyelid and lacrimal, were minimal in this cohort. For most patients, the prescription exceeded needs. Younger age but not gender was associated with opioid use versus not. Most did not properly discard these medications. Quality improvement in both the dispensing and disposal of opioids in oculofacial surgical practice may be warranted.

Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

“…However, a 2019 survey study among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery showed that postoperative opioids for oculoplastic and orbital procedures were prescribed at a higher rate than for procedures of other ophthalmic subspecialties and than the national mean. Further, recent studies on opioid use in oculoplastic and orbital surgery demonstrated that prescriptions frequently exceeded patients’ needs . In this study, we aimed to perform an in-depth examination of opioid prescribing patterns for oculoplastic and orbital procedures and identify changes in prescribing patterns before and after enactment of statewide opioid legislation.…”

“…Further, recent studies on opioid use in oculoplastic and orbital surgery demonstrated that prescriptions frequently exceeded patients' needs. 12,13 In this study, we aimed to perform an in-depth examination of opioid prescribing patterns for oculoplastic and orbital procedures and identify changes in prescribing patterns before and after enactment of statewide opioid legislation.…”