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No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol
BACKGROUND: From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. METHODS: A multimodal analgesic protocol consisting of 15 components en...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787342/ https://www.ncbi.nlm.nih.gov/pubmed/33425613 http://dx.doi.org/10.1097/GOX.0000000000003305 |
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author | Hall, Bradley R. Billue, Katherine L. Hon, Heidi Sanders, Stacey E. Barrientos, Stephan Flores, Laura E. Nicholas, Thomas Shostrom, Valerie Meyer, Bria Johnson, Perry J. |
author_facet | Hall, Bradley R. Billue, Katherine L. Hon, Heidi Sanders, Stacey E. Barrientos, Stephan Flores, Laura E. Nicholas, Thomas Shostrom, Valerie Meyer, Bria Johnson, Perry J. |
author_sort | Hall, Bradley R. |
collection | PubMed |
description | BACKGROUND: From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. METHODS: A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients. RESULTS: Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3–81), and median total requirement was 20 mg morphine equivalents (range 7.5–85). Protocol compliance inversely correlated to opioid use (P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1–5 (P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups. CONCLUSION: This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction. |
format | Online Article Text |
id | pubmed-7787342 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-77873422021-01-07 No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol Hall, Bradley R. Billue, Katherine L. Hon, Heidi Sanders, Stacey E. Barrientos, Stephan Flores, Laura E. Nicholas, Thomas Shostrom, Valerie Meyer, Bria Johnson, Perry J. Plast Reconstr Surg Glob Open Cosmetic BACKGROUND: From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. METHODS: A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients. RESULTS: Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3–81), and median total requirement was 20 mg morphine equivalents (range 7.5–85). Protocol compliance inversely correlated to opioid use (P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1–5 (P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups. CONCLUSION: This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction. Lippincott Williams & Wilkins 2020-12-21 /pmc/articles/PMC7787342/ /pubmed/33425613 http://dx.doi.org/10.1097/GOX.0000000000003305 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Cosmetic Hall, Bradley R. Billue, Katherine L. Hon, Heidi Sanders, Stacey E. Barrientos, Stephan Flores, Laura E. Nicholas, Thomas Shostrom, Valerie Meyer, Bria Johnson, Perry J. No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title | No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title_full | No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title_fullStr | No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title_full_unstemmed | No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title_short | No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol |
title_sort | no opioids after septorhinoplasty: a multimodal analgesic protocol |
topic | Cosmetic |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787342/ https://www.ncbi.nlm.nih.gov/pubmed/33425613 http://dx.doi.org/10.1097/GOX.0000000000003305 |
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