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Otolaryngol Head Neck Surg. 2019 Mar;160(3):402-408. doi: 10.1177/0194599818803343. Epub 2018 Oct 16.

Postoperative Opioid Use in Sinonasal Surgery.

Author information

1
1 Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
2
2 Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
3
3 Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA.
4
4 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
5
5 Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
6
6 Deptartment of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
7
7 Friends Select School, Philadelphia, Pennsylvania, USA.

Abstract

OBJECTIVE:

To survey patients following sinonasal surgery regarding postoperative pain and opioid use.

STUDY DESIGN:

Patients were surveyed for 4 days following sinus and/or nasal surgery regarding their pain level and use of prescribed opioids.

SETTING:

Four academic medical centers and 1 private practice institution.

SUBJECTS:

Consecutive adult patients undergoing sinonasal surgery.

RESULTS:

A total of 219 subjects met criteria and were included for analysis; 134 patients (61%) took 5 or fewer combination oxycodone (5-mg) and acetaminophen (325-mg) tablets in the first 3 postoperative days, and 196 patients (89.5%) took fewer than 15. Fifty-one patients (23%) consumed no opioid pain medication. Opioid consumption was positively correlated with postoperative pain ( R2 = 0.2, P < .01) but was not correlated with the use of acetaminophen ( R2 = 0.002, P = .48). No significant difference in postoperative pain or opioid consumption was seen with respect to age, sex, specific procedures performed, postoperative steroids, or smoking history. Current smokers reported higher average pain than nonsmokers ( P < .001) and also required more postoperative opioids ( P = .02).

CONCLUSIONS:

An evidence-based approach to postoperative pain control following sinonasal surgery that reduces the number of unused and potentially diverted opioids is needed. The current study suggests that 15 combination oxycodone (5-mg) and acetaminophen (325-mg) tablets provide sufficient pain control for 90% of patients in the immediate postoperative period following sinonasal surgery, irrespective of the specific procedures performed, use of acetaminophen, or use of systemic steroids. Smoking status may help surgeons predict which patients will require larger opioid prescriptions.

KEYWORDS:

opioids; pain; prescription; rhinoplasty; sinonasal; sinus surgery; surgery

PMID:
30324849
DOI:
10.1177/0194599818803343

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