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Postoperative Opioid Use in Sinonasal Surgery.

Garrett D Locketz1, Jason D Brant1, Nithin D Adappa1

  • 11 Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|October 17, 2018
PubMed
Summary

Most sinonasal surgery patients require fewer than 15 opioid tablets post-surgery. Smoking status is a key factor in predicting higher pain and opioid needs, guiding better pain management strategies.

Keywords:
opioidspainprescriptionrhinoplastysinonasalsinus surgerysurgery

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Area of Science:

  • Otolaryngology
  • Pain Management
  • Pharmacology

Background:

  • Postoperative pain and opioid use after sinonasal surgery require careful management to prevent overuse and diversion.
  • Current prescribing practices may not be optimized for individual patient needs.

Purpose of the Study:

  • To survey patients undergoing sinonasal surgery to understand their postoperative pain levels and opioid consumption patterns.
  • To identify factors influencing pain and opioid use to inform evidence-based prescribing.

Main Methods:

  • A survey was conducted over 4 days with adult patients following sinus and/or nasal surgery at multiple institutions.
  • 219 patients were analyzed for pain scores and use of combination oxycodone-acetaminophen, with correlation to other factors.

Main Results:

  • 89.5% of patients used fewer than 15 opioid tablets in the first 3 days; 23% used no opioids.
  • Opioid use correlated positively with pain (R²=0.2) but not with acetaminophen use.
  • Current smokers reported higher pain and required more opioids compared to nonsmokers.

Conclusions:

  • A guideline of 15 opioid tablets appears sufficient for 90% of patients post-sinonasal surgery.
  • Prescribing should consider individual factors, particularly smoking status, to optimize pain control and minimize opioid waste.
  • An evidence-based approach is needed to reduce unused and potentially diverted opioids.