Postoperative pain and analgesic requirements after septoplasty and rhinoplasty.
Adolescent
Adult
Aged
Analgesics, Opioid
/ therapeutic use
Drug Prescriptions
/ statistics & numerical data
Female
Humans
Male
Middle Aged
Nasal Septum
/ surgery
Pain Management
/ methods
Pain Measurement
Pain, Postoperative
/ drug therapy
Prospective Studies
Rhinoplasty
/ adverse effects
Young Adult
Analgesia
opioids
pain
rhinoplasty
septoplasty
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
28
12
2018
revised:
24
01
2019
accepted:
15
02
2019
pubmed:
8
3
2019
medline:
24
10
2019
entrez:
8
3
2019
Statut:
ppublish
Résumé
To assess and define the level of pain after rhinoplasty and septoplasty and to better define the strength and quantity of postoperative opioids needed. Prospective outcomes research. Two groups of patients were enrolled. One group underwent septoplasty with/without turbinate reduction and the other group underwent functional and/or cosmetic rhinoplasty (with/without septoplasty). Patients completed a 15-day log (daily, beginning on the day of surgery) to record the analgesics used and the daily maximal level of pain using a visual analog scale. Level of pain, number of days of moderate or severe pain, total number of opioid pills used, and total morphine milligram equivalents (MMEs) of opioid used were assessed. Pain after septoplasty and rhinoplasty was generally mild. Average pain was moderate through postoperative day (POD) 2 after rhinoplasty and only on POD 0 after septoplasty. There was no statistically significant difference between the two groups in terms of number of opioid tablets consumed or total MMEs used. Patients undergoing rhinoplasty consumed more acetaminophen than septoplasty-only patients (7471 ± 1009 vs. 2781 ± 585, P = .0112). Ninety percent of patients would have received adequate analgesia with as few as 11 opioid tablets. All patients had excess opioid at the end of the study period. Both septoplasty and rhinoplasty are associated with mostly mild pain, and postoperative opioid requirements are quite low. Surgeons can reliably reduce opioid prescription after septoplasty and rhinoplasty to as few as 11 tablets. Reducing opioid prescribing will not adversely affect the patient but will reduce the availability of opioids for misuse or diversion. 2c Laryngoscope, 129:2020-2025, 2019.
Substances chimiques
Analgesics, Opioid
0
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2020-2025Informations de copyright
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
Références
CDC Opioid Prescribing Guidelines. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed December 2, 2018.
New York State Prescription Monitoring Program Registry. https://commerce.health.state.ny.us/doh2/applinks/cspnp/PatientSearch.action. Accessed December 2, 2018. https://www.health.ny.gov/professionals/narcotic/prescription_monitoring/docs/pmp_registry_faq.pdf
CDC, Drug Overdose Death Data. https://www.cdc.gov/drugoverdose/data/statedeaths.html. Accessed December 1, 2018.
National Institute on Drug Abuse. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed November 25, 2018.
Rudd RA, Set P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths-United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016;65:1-8.
Han B, Compton WM, Blanco C, et al. Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 national survey on drug use and health. Ann Intern Med 2017;167:293-301.
National Institute on Drug Abuse, Overdose Death Rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed December 1, 2018.
Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med 2016;374:154-163.
Mateu-Gelabert P, Guarino H, Jessell L, Teper A. Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City. J Subst Abuse Treat 2015;48:13-20.
Bicket MC, Long JJ, Pronovost PJ, Alexander GC. Prescription opioid analgesics commonly unused after surgery. A systematic review. JAMA Surg 2017;152:1066-1071.
Hwang CS, Kang EM, Kornegay CJ, et al. Trends in the concomitant prescribing of opioids and benzodiazepines, 2002-2014. Am J Prev Med 2016;51:151-160.
Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol 2011;185:551-555.
Bartels K, Mayes LM, Dingmann C, et al. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One 2016;11:e0147972.
Department of Veterans Affairs. Pain as the 5th Vital Sign Toolkit. Washington, DC: Veterans Health Administration; 2000.
Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery: retrospective cohort study. Arch Intern Med 2012;172:425-430.
Brummett CM, Waljee JF, Goesling J. New persistent opioid use after minor and major surgical procedures in US Adults. JAMA Surg 2017;152:e170504.
Rodgers J, Cunningham K, Fitzgerald K, Finnerty E. Opioid consumption following outpatient upper extremity surgery. J Hand Surg 2012;37A:645-650.
Schwartz MA, Naples JG, Kuo C-L, Falcone TE. Opioid prescribing patterns among otolaryngologists. Otolaryngol Head Neck Surg 2018;158:854-859.
Patel S, Sturm A, Bobian M, et al. Opioid use by patients after rhinoplasty. JAMA Facial Plast Surg 2018;20:24-30.
Sethi RKV, Lee LN, Quatela OE, et al. Opioid prescription patterns after rhinoplasty. JAMA Facial Plast Surg 2019;21:76-77.
Szychta P, Antoszewski B. Assessment of early post-operative pain following septorhinoplasty. J Laryngol Otol 2010;124:1194-1199.
Bodian CA, Freedman G, Hossain S, et al. The visual analog scale for pain. Anesthesiology 2001;95:1356-1361.
Myles PS, Myls DB, Galagher W, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptance symptoms state. Br J Anesthesiol 2017;118:424-429.
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003;4:407-414.
Militsakh O, Lydiatt W, Lydatta D, et al. Development of multimodal analgesia pathways in outpatient and parathyroid surgery and association with postoperative opioid prescription patterns. JAMA Otolaryngol Head Neck Surg 2018;144:1023-1029.
Shindo M, Lim, J, Leon E, et al. Opioid prescribing practice and needs in thyroid and parathyroid [published online October 25, 2018]. JAMA Otolaryngol Head Neck Surg doi:https://doi.org/10.1001/jamaoto.2018.2427.
Zgierska A, Miller M, Rabago D. Patient satisfaction, prescription drug abuse, and potential unintended consequences. JAMA 2018;307:1377-1378.