Improving Multimodal Analgesic Use After Otolaryngologic Surgery-A Single-Institution Experience of 9000 Patients

This study aims to assess a quality improvement intervention to decrease opiate prescriptions at discharge and improve patient access to multimodal analgesics (MMA) after otolaryngologic surgery.

Longitudinal quality improvement initiative with retrospective prescription trend review and prospective patient questionnaire collection.

An academic medical center.

Opioid, acetaminophen, and non-steroidal anti-inflammatory drug (NSAID) discharge prescriptions after otolaryngologic procedures were reviewed. Two annual department-wide workshops were carried out to review the literature on published MMA protocols and develop standardized post-operative pain medication instructions to reduce opioid use. Concurrently, a patient survey was distributed to evaluate discharge pain medication use and satisfaction with pain control.

Discharge pain medications were reviewed for 9064 procedures between January 2021 and May 2024. After the interventions above, the percentage of patients receiving opioids at discharge decreased from 61.4% to 46.8% (P < .00001). Concurrently, acetaminophen and NSAID discharge prescriptions increased from 24.3% and 10.2% to 67.4% and 46.1%, respectively (both P < .00001). Among 100 patients surveyed, satisfaction with post-operative pain control was high before and after the implementation of standardized discharge instructions, even though fewer post-intervention patients received opioids at discharge (49.1% compared to 76.6% pre-intervention, P = .007). Notably, 27% of patients prescribed opioids reported not taking them and 23% reported saving unused opioids for future use.

Implementation of standardized post-operative pain medication instructions at discharge after otolaryngologic procedures led to a substantial decrease in opioids prescribed while maintaining patient satisfaction with post-operative pain management. A significant proportion of patients reported saving unused opioids for future use despite standardized safe disposal instructions.