Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review

Nguyen, Brandon; Stathakios, James; Quan, Daniel; Pinto, Jessica; Lin, Ho‐Sheng; Pashkova, Anna A.; Svider, Peter F.

doi:10.1177/0003489420919134

Cited by 15 publications

(9 citation statements)

References 73 publications

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“…We attribute this finding to our use of various opioid‐sparing regimens and multimodal analgesic combinations for pain control. In the current opioid epidemic in which we live, perioperative opioid abuse has been linked to future abuse, requiring surgeons to carefully consider and evaluate their prescribing practices 52 , 53 . Because of this, the use of multimodal analgesia as part of ERAS protocols and clinical pathways is an important step in lowering systemic opioid abuse and improving physician stewardship.…”

Section: Discussionmentioning

confidence: 99%

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

Chorath

Luu

et al. 2021

Otolaryngol.--head neck surg.

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Objective Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. Data Source A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. Review Methods Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. Results A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, –0.64 days [95% CI, −0.92 to −0.37]) and hospital costs (in US dollars; mean difference, –307.70 [95% CI, −346.49 to −268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). Conclusion There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.

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Section: Discussionmentioning

confidence: 99%

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

Chorath

Luu

et al. 2021

Otolaryngol.--head neck surg.

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“…In a recent review of non-opioid analgesics for pain management after thyroid surgery, local anesthetics and nonsteroidal anti-inflammatory drugs (NSAIDs) were highly recommended. Acetaminophen, gabapentin, and ketamine have been noted as adequate alternatives [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy

Gau

Huang

et al. 2023

Medicina

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Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy.

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“…While such initiatives are an integral part of the solution, understanding procedure‐specific analgesic requirements is a fundamental step in limiting over‐prescription. Use of multi‐modal analgesia (MMA) regimens, incorporating ibuprofen and acetaminophen, have been shown to reduce overall opioid consumption 12,13 . However, given the complexity and psychological nature of pain, there will often exist a minority of patients who report higher pain scores postoperatively, use a disproportionate amount of analgesics, and experience pain for longer periods 14 .…”

Section: Introductionmentioning

confidence: 99%

“…Use of multi‐modal analgesia (MMA) regimens, incorporating ibuprofen and acetaminophen, have been shown to reduce overall opioid consumption. 12 , 13 However, given the complexity and psychological nature of pain, there will often exist a minority of patients who report higher pain scores postoperatively, use a disproportionate amount of analgesics, and experience pain for longer periods. 14 The challenge becomes how to reduce overall over‐prescription and unnecessary consumption while limiting the number of patients who experience unmanaged pain.…”

Section: Introductionmentioning

confidence: 99%

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Hamour

Manojlovic-Kolarski

Eskander

et al. 2023

Laryngoscope Investig Oto

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Background: Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia. Methods: Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans. Results: A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling (n = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, p < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, p < .05). Patients who received local anesthesia peri-operatively (46.4%, n = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), p < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), p < .05]. Conclusion: Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction.

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Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review

Cited by 15 publications

References 73 publications

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

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