Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery

Ndon, Sifon; Spock, Todd; Torabi, Sina J.; Manes, R. Peter

doi:10.1177/0194599820915472

Cited by 13 publications

(28 citation statements)

References 25 publications

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“…Specifically, NSAIDs have been avoided after FESS because of the risk of epistaxis. However, NSAIDs have been shown to be safe and effective in perioperative pain management after FESS and nasal surgeries in several recent studies . There is growing evidence that NSAIDs may decrease the requirement for rescue analgesics, including opioids .…”

mentioning

confidence: 99%

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Walgama

Genç

et al. 2019

Int Forum Allergy Rhinol

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Background:The taboo of avoiding nonsteroidal antiinflammatory drugs (NSAIDs) a er functional endoscopic sinus surgery (FESS) has been waning. The impetus to reduce opioid prescriptions in view of the opioid epidemic led the authors to change their practices to include NSAIDs a er sinus surgery. This study's aim was to analyze the differences between patients before and a er we began recommending NSAIDs a er FESS. Methods:A prospective cohort study was performed on patients undergoing FESS or other endoscopic nasal surgeries at 3 institutions, by 5 rhinologists and 1 facial plastic surgeon. Before introducing NSAIDs, all patients were given a prescription for hydrocodone-acetaminophen 5/325 mg and also recommended preferentially to use acetaminophen 325 mg. A er the addition of NSAIDs, ibuprofen 200 mg and acetaminophen 325 mg were recommended preferentially, using the narcotic as a rescue medication. Patients kept a pain diary and medication log, and gave a visual analog scale (VAS) score for overall pain. Demographics, surgical variables, and comorbidities were also analyzed. Results:One hundred sixty-six total patients were recruited and had data that could be analyzed (65 without NSAIDs, 101 with NSAIDs). Overall, mean pain VAS score was 3.12 ± 1.95 for the non-NSAID group and 2.33 ± 2.30 for the NSAID group (p value = 0.006). The day with the highest mean pain was the first postoperative day. The mean number of total opioid pills taken was 6.94 ± 6.85 without NSAIDs vs 3.77 ± 4.56 with NSAIDs (p = 0.018). Age and gender were found to be the only consistently significant patient variables to affect pain. There were no bleeding complications.Conclusion: NSAID use was introduced into the practices of 5 practicing rhinologists and 1 facial plastic surgeon. No bleeding complications were seen. Both pain and overall opioid usage were reduced significantly. C 2019 ARS-AAOA, LLC.

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confidence: 99%

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Walgama

Genç

et al. 2019

Int Forum Allergy Rhinol

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“…A recently published prospective case series of 64 patients by Ndon et al demonstrated that the average number of narcotic pills consumed over a 7‐day postoperative period was 7.7 (SD 7.6). This study identified no demographic or surgical risk factors but did find that narcotic use correlated with higher POD1 pain scores ( P < .001) 5 . Studies in the literature assessing pain levels after FESS and non‐narcotic pain management alternatives, however, remain sparse.…”

Section: Introductionmentioning

confidence: 74%

Assessment of narcotic use in management of post‐op pain after functional endoscopic sinus surgery

Gill

Chitguppi

Haggerty

et al. 2021

Laryngoscope Investig Oto

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Objectives Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen. Methods Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1‐3), moderate (4‐7), or severe (8‐10). Patients were categorized into narcotics, non‐narcotics, combination, or none based on type of analgesic used. Results Sixty‐nine patients were included. Majority of patients reported either mild (39%) or no pain (28%) during the first 5 PODs. Mean POD1 pain score was 3.98, which decreased with each subsequent POD. On POD1, 37% used opioids (n = 37), 32% used non‐opioids (n = 32), 22% used a combination (n = 22), and 9% used no pain meds (n = 9). Mean number of narcotic pills used within the first 5 PODs was 2 pills on any given day. Age was inversely associated with reported POD1 pain scores (P = .003) and use of preoperative steroids in patients with sinonasal polyposis was associated with lower POD1 pain scores (P = .03). Conclusions Even on POD1, majority of patients experienced either mild or no pain, and this decreases with each POD. Narcotics are grossly overprescribed and underutilized by patients postoperatively after FESS. We advocate for more judicious prescribing habits of narcotics by Otolaryngologists after FESS, and emphasize relying on non‐narcotic alternatives like Acetaminophen or NSAIDS to diminish narcotic use and abuse in the postoperative period. Level of Evidence 4.

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“…Sethi et al showed that typically 15.6 tablets were prescribed for patients following ESS, 3 and Ndon et al showed that mean opioid use over a 7-day period after ESS was 7.7 pills (SD ± 7.6). 7 EETS patients received a similar amount (15.7 tablets) on discharge, likely because EETS is an inpatient surgery, compared to ESS being an outpatient surgery; thus, opioid requirements by the day of discharge were lower than if they were discharged on the day of surgery. A limitation of our study, given its retrospective nature, is that we did not ask patients to prospectively record their analgesia usage at home, which would provide a more accurate measure of post-discharge analgesia usage.…”

Section: Discussionmentioning

confidence: 99%

“…3 Improving opioid prescribing practices, both in the hospital and on discharge, remains a key strategy in curtailing the quantity of prescriptions and, thereby, minimizing opportunities for prescription diversion and opioid-related complications. 4 Recent studies have looked at optimizing perioperative pain regimens among patients undergoing endoscopic sinus surgery (ESS) 3,[5][6][7][8] and septorhinoplasty. 9 Few studies have examined pain management after endoscopic endonasal transsphenoidal surgery (EETS).…”

Section: Introductionmentioning

confidence: 99%

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Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

Kianian

Villalpando

et al. 2021

Am J Rhinol�Allergy

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Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

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Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery

Cited by 13 publications

References 25 publications

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Assessment of narcotic use in management of post‐op pain after functional endoscopic sinus surgery

Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

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