USA: A recent guideline, published in the SAGE journal Otolaryngology-Head and Neck Surgery, reports on opioid prescribing for analgesia after common otolaryngology operations.
Opioid use disorder (OUD) is defined as physical and psychological reliance on opioid that includes the morbidity of dependence and mortality of overdose. Overprescription of opioids can lead to chronic use and misuse, and unused narcotics after surgery can lead to their diversion. The authors note that reducing the number of extra opioids available after surgery through smaller prescriptions, safe storage, and disposal can reduce the risk of opioid use disorder in otolaryngology patients and their families.
The guideline by Samantha Anne, Head & Neck Institute, Cleveland, Ohio, USA, and colleagues was aimed at identifying quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures.
The guideline addresses the assessment of the patient for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and the responsible use of opioids. Last, safe disposal of unused opioids is discussed.
Key action statements include:
Expected pain: Prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain.
Modifying factors: Prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain.
Risk factors for opioid use disorder: Prior to surgery, clinicians should identify risk factors for OUD when analgesia using opioids is anticipated.
Patients at risk for opioid use disorder: In patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan.
Shared decision making: Clinicians should promote shared decision making by informing patients of the benefits and risks of postoperative pain treatments that include nonopioid analgesics, opioid analgesics, and nonpharmacologic interventions.
Multimodal therapy: Clinicians should develop a multimodal treatment plan for managing postoperative pain.
Nonopioid analgesia: Clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery.
Opioid prescribing: When treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration.
Patient feedback: Clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur.
Stopping pain medications: Clinicians should educate patients to stop opioids when pain is controlled with nonopioids and to stop all analgesics when pain has resolved.
Storage and disposal of opioids: Clinicians should recommend that patients (or their caregivers) store prescribed opioids securely and dispose of unused opioids through take-back programs or another accepted method.
Assessment of pain control with opioids: Clinicians should inquire, within 30 days of surgery, whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan.
"This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not a comprehensive guide on pain management in otolaryngologic procedures. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experiences and assessments of individual patients," concluded the authors.
Reference:
Anne S, Mims J "Whit," Tunkel DE, et al. Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations Executive Summary. Otolaryngology–Head and Neck Surgery. 2021;164(4):687-703. doi:10.1177/0194599821996303