Rates of Opioid Prescriptions Obtained After Mohs Surgery

Veerabagu, Surya; Cheng, Brian T.; Wang, Sonia; Etzkorn, Jeremy R.; Kilaru, Austin S.; Noe, Megan H.; Miller, Christopher J.; Sobanko, Joseph F.; Shin, Thuzar M.; Higgins, H. William; McMurray, Stacy L.; Krausz, Aimee; Walker, J.; Giordano, Cerrene N.

doi:10.1001/jamadermatol.2021.3468

Cited by 9 publications

(7 citation statements)

References 39 publications

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“…9 Although there has been a decline over the past decade, 11.7% of MMS patients filled postoperative opioid prescriptions in 2020. 17 Pain after most MMS procedures can be controlled with non-narcotic measures. 5 Although a Delphi consensus of MMS surgeons in 2020 was unable to identify any scenario where opioids were always recommended after MMS, 8 certain reconstructions and tumor locations have been shown to have higher postoperative pain levels and potential need for narcotics.…”

Section: Discussionmentioning

confidence: 99%

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Voss

Veerabagu

et al. 2022

Dermatol Surg

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BACKGROUND Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS). OBJECTIVE Evaluate how bupivacaine affects postoperative pain and narcotic use. MATERIALS AND METHODS In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0–10), and whether pain was controlled. RESULTS One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08–4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91–5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28–5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73–2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred. CONCLUSION Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.

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Section: Discussionmentioning

confidence: 99%

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Voss

Veerabagu

et al. 2022

Dermatol Surg

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“…Prior analyses suggest that opioids are used less in MMS compared with other disciplines, 6 and utilization may be decreasing, which is consistent with our study. 11 As surgeons tended to prescribe short courses of opioids regardless of experience, it is possible that a recent focus on providing consensus recommendations on opioid use may be influencing younger Mohs surgeons. 12 Benzodiazepine use was low overall and seems to be becoming even less prevalent among younger surgeons.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database

2022

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“…In the US, approximately 26% of patients who underwent Mohs micrographic surgery (MMS) from January 2009 to June 2020 filled an opioid prescription . During that time, the percentage of patients who filled an opioid prescription after MMS increased to 39.6% in 2011, and decreased annually thereafter to 11.7% in 2020 . The duration of opioid prescriptions after MMS was short, ie, averaging 3 to 5 days .…”

Section: Introductionmentioning

confidence: 99%

“…During that time, the percentage of patients who filled an opioid prescription after MMS increased to 39.6% in 2011, and decreased annually thereafter to 11.7% in 2020 . The duration of opioid prescriptions after MMS was short, ie, averaging 3 to 5 days . In other medical specialties, short-term opioid use after surgery may be associated with the development of continued, long-term opioid use (odds ratios, 1.28 [cesarean birth] to 5.10 [total knee arthroplasty]) .…”

Section: Introductionmentioning

confidence: 99%

“…1 The duration of opioid prescriptions after MMS was short, ie, averaging 3 to 5 days. 1,2 In other medical specialties, short-term opioid use after surgery may be associated with the development of continued, long-term opioid use (odds ratios, 1.28 [cesarean birth] to 5.10 [total knee arthroplasty]). 3 In the primary care setting, up to 25% of individuals who fill long-term opioid prescriptions may struggle with opioid addiction.…”

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confidence: 99%

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Patient Preferences for Pain Control After Mohs Micrographic Surgery

et al. 2023

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ImportancePatient preferences for pain medications after Mohs micrographic surgery are important to understand and have not been fully studied.ObjectiveTo evaluate patient preferences for pain management with only over-the-counter medications (OTCs) or OTCs plus opioids after Mohs micrographic surgery given varying levels of theoretical pain and opioid addiction risk.Design, Setting, and ParticipantsThis prospective discrete choice experiment was conducted in a single academic medical center from August 2021 to April 2022 among patients undergoing Mohs surgery and their accompanying support persons (≥18 years). A prospective survey was administered to all participants using the Conjointly platform. Data were analyzed from May 2022 to February 2023.Main outcome and measureThe primary outcome was the pain level at which half of the respondents chose OTCs plus opioids equally to only OTCs for pain management. This pain threshold was determined for varying opioid addiction risk profiles (low, 0%; low-moderate, 2%; moderate-high, 6%; high, 12%) and measured via a discrete choice experiment and linear interpolation of associated parameters (pain levels and risk of addiction).ResultsOf the 295 respondents (mean [SD] age, 64.6 [13.1] years; 174 [59%] were female; race and ethnicity were not considered) who completed the discrete choice experiment, 101 (34%) stated that they would never consider opioids for pain management regardless of the pain level experienced, and 147 (50%) expressed concern regarding possible opioid addiction. Across all scenarios, 224 respondents (76%) preferred only OTCs vs OTCs plus opioids after Mohs surgery for pain control. When the theoretical risk of addiction was low (0%), half of the respondents expressed a preference for OTCs plus opioids given pain levels of 6.5 on a 10-point scale (90% CI, 5.7-7.5). At higher opioid addiction risk profiles (2%, 6%, 12%), an equal preference for OTCs plus opioids and only OTCs was not achieved. In these scenarios, patients favored only OTCs despite experiencing high levels of pain.Conclusion and relevanceThe findings of this prospective discrete choice experiment indicate that the perceived risk of opioid addiction affects the patient’s choice of pain medications after Mohs surgery. It is important to engage patients undergoing Mohs surgery in shared decision-making discussions to determine the optimal pain control plan for each individual. These findings may encourage future research on the risks associated with long-term opioid use after Mohs surgery.

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Rates of Opioid Prescriptions Obtained After Mohs Surgery

Cited by 9 publications

References 39 publications

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery

Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database

Patient Preferences for Pain Control After Mohs Micrographic Surgery

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