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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Opioids | Research

Opioid versus non-opioid postoperative pain management in otolaryngology

Authors: Allison Keane, Kayla Jardine, David Goldenberg, Sandeep Pradhan, Jay Zhu, Jobran Mansour, Hadas Knoller, Ron Eshel, Yoav P. Talmi, Sonia Vaida, Guy Slonimsky

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

Background

The opioid epidemic in the United States has had devastating consequences, with many opioid-related deaths and a significant economic toll. Opioids have a significant role in postoperative pain management. Here we aim to analyze differences in postoperative opioid and non-opioid pain medications regimens following common otolaryngological surgeries between two large tertiary care medical centers: the Milton S. Hershey Medical Center, USA (HMC) and The Chaim Sheba Medical center, Israel (SMC).

Methods

A retrospective chart review of patients undergoing common otolaryngological procedures during the years 2017–2019 was conducted at two tertiary care centers, one in the U.S. and the other in Israel. Types and doses of postoperative pain medications ordered and administered during admission were analyzed. Average doses ordered and administered in 24 h were calculated. Opioid medications were converted to a standardized unit of morphine milliequivalents (MME). Chi-square test and Wilcoxon rank-sum test were used to compare the groups.

Results

The study included 204 patients (103 U.S., 101 Israel). Patient demographics were similar except for a longer length of stay in Israel (p < 0.01). In the U.S., 95% of patients were ordered opioids compared to 70% in Israel (P < 0.01). In the U.S., 68.9% of patients ordered opioids received the medications compared to 29.7% in Israel. The median opioid dose ordered in the U.S. was 45MME/24 h compared to 30MME/24 h in Israel (P < 0.01), while median dose received in the U.S. was 15MME/24 h compared to 3.8MME/24 h in Israel (P < 0.01). Opioid prescriptions at discharge were given to 92% of patients in the U.S. compared to 4% of patients in Israel (p < 0.01). A significantly higher number of patients in the U.S. were prescribed acetaminophen and ibuprofen (p < 0.0001). Dipyrone was prescribed to 78% of patients in Israel.

Conclusions

HMC demonstrated a significantly more permissive approach to both prescribing and consuming opioid medications for postoperative pain management than SMC for similar, common otolaryngological surgeries. Non-opioid alternatives and examining the cultural and medical practice-based differences contributing to the opioid epidemic should be discussed and reevaluated.
Literature
1.
2.
3.
Salvatore PP, Guy GP, Mikosz CA. Changes in opioid dispensing by medical specialties after the release of the 2016 CDC guideline for prescribing opioids for chronic pain. Pain Med. 2022;23(11):1908–14.PubMedCrossRef
4.
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12(4):657–67.PubMedCrossRef
5.
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med. 2015;49(3):409–13.PubMedPubMedCentralCrossRef
6.
Schwartz MA, Naples JG, Kuo CL, Falcone TE. Opioid prescribing patterns among otolaryngologists. Otolaryngol Head Neck Surg. 2018;158(5):854–9.PubMedCrossRef
7.
Svider PF, Arianpour K, Guo E, Folbe E, Zuliani G, Lin H, et al. Opioid prescribing patterns among otolaryngologists: crucial insights among the medicare population. Laryngoscope. 2018;128(7):1576–81.PubMedCrossRef
8.
Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer CJ, Binswanger IA. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One. 2016;11(1):e0147972.PubMedPubMedCentralCrossRef
9.
Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152(11):1066–71.PubMedPubMedCentralCrossRef
10.
Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.PubMedCrossRef
11.
Relieving Pain in America. A blueprint for transforming prevention, care, education, and research. The National Academies Collection: Reports funded by National Institutes of Health: Washington (DC); 2011.
12.
Manchikanti L, Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, et al. Opioid epidemic in the United States. Pain Physician. 2012;15(3 Suppl):ES9-38.PubMedCrossRef
13.
Ponizovsky AM, Marom E, Zeldin A, Cherny NI. Trends in opioid analgesics consumption, Israel, 2000–2008. Eur J Clin Pharmacol. 2011;67(2):165–8.PubMedCrossRef
14.
Silbermann M. Current trends in opioid consumption globally and in Middle Eastern countries. J Pediatr Hematol Oncol. 2011;33(Suppl 1):S1-5.PubMedCrossRef
15.
Banos JE, Barajas C, Martin ML, Hansen E, Cos MA, Bosch F, et al. A survey of postoperative pain treatment in children of 3–14 years. Eur J Pain. 1999;3(3):275–82.PubMedCrossRef
16.
Fieler M, Eich C, Becke K, Badelt G, Leimkuhler K, Messroghli L, et al. Metamizole for postoperative pain therapy in 1177 children: a prospective, multicentre, observational, postauthorisation safety study. Eur J Anaesthesiol. 2015;32(12):839–43.PubMedCrossRef
17.
Kocum AI, Sener M, Caliskan E, Bozdogan N, Micozkadioglu D, Yilmaz I, et al. Intravenous paracetamol and dipyrone for postoperative analgesia after day-case tonsillectomy in children: a prospective, randomized, double blind, placebo controlled study. Braz J Otorhinolaryngol. 2013;79(1):89–94.PubMedCrossRef
18.
Messerer B, Grogl G, Stromer W, Jaksch W. Pediatric perioperative systemic pain therapy: Austrian interdisciplinary recommendations on pediatric perioperative pain management. Schmerz. 2014;28(1):43–64.PubMedCrossRef
19.
Shimoni Z, Varon D, Froom P. Minimal use of opioids for pain relief in an internal medicine department. South Med J. 2018;111(5):288–92.PubMedCrossRef
20.
Rogosch T, Sinning C, Podlewski A, Watzer B, Schlosburg J, Lichtman AH, et al. Novel bioactive metabolites of dipyrone (metamizol). Bioorg Med Chem. 2012;20(1):101–7.PubMedCrossRef
21.
22.
de Leeuw TG, Dirckx M, Gonzalez Candel A, Scoones GP, Huygen F, de Wildt SN. The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review. Paediatr Anaesth. 2017;27(12):1193–201.PubMedCrossRef
23.
Miescher PA, Pola W. Haematological effects of non-narcotic analgesics. Drugs. 1986;32(4):90–108.PubMedCrossRef
24.
25.
Risks of agranulocytosis and aplastic anemia. A first report of their relation to drug use with special reference to analgesics. The International Agranulocytosis and Aplastic Anemia Study. JAMA. 1986;256(13):1749–57.
26.
Andersohn F, Konzen C, Garbe E. Systematic review: agranulocytosis induced by nonchemotherapy drugs. Ann Intern Med. 2007;146(9):657–65.PubMedCrossRef
27.
Andrade SE, Martinez C, Walker AM. Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol. 1998;51(12):1357–65.PubMedCrossRef
28.
Edwards JE, McQuay HJ. Dipyrone and agranulocytosis: what is the risk? Lancet. 2002;360(9344):1438.PubMedCrossRef
29.
Hamerschlak N, Cavalcanti AB. Neutropenia, agranulocytosis and dipyrone. Sao Paulo Med J. 2005;123(5):247–9.PubMedCrossRef
30.
Hedenmalm K, Spigset O. Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol. 2002;58(4):265–74.PubMedCrossRef
31.
Kotter T, da Costa BR, Fassler M, Blozik E, Linde K, Juni P, et al. Metamizole-associated adverse events: a systematic review and meta-analysis. PLoS One. 2015;10(4):e0122918.PubMedPubMedCentralCrossRef
32.
Kramer MS, Lane DA, Hutchinson TA. The international agranulocytosis and aplastic anemia study (IAAAS). J Clin Epidemiol. 1988;41(6):613.PubMedCrossRef
33.
34.
Ninan B, Wertheimer AI. Withdrawing drugs in the US versus other countries. 2012.
35.
Secretariat UN, Economic UNDoI. Consolidated List of Products Whose Consumption And/or Sale Have Been Banned, Withdrawn, Severely Restricted Or Not Approved by Governments: UN; 2002.
36.
Moore RA, Wiffen PJ, Derry S, Maguire T, Roy YM, Tyrrell L. Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;11:CD010794.
37.
Li RJ, Li ML, Leon E, Ng CW, Shindo M, Manzione K, et al. Comparison of opioid utilization patterns after major head and neck procedures between Hong Kong and the United States. JAMA Otolaryngology-Head & Neck Surgery. 2018;144(11):1060–5.CrossRef
38.
Choo S, Nogan S, Matrka L. Postoperative opioid prescribing and consumption patterns after tonsillectomy. Otolaryngol Head Neck Surg. 2019;161(6):960–6.PubMedCrossRef
39.
Pruitt LC, Swords DS, Russell KW, Rollins MD, Skarda DE. Prescription vs. consumption: Opioid overprescription to children after common surgical procedures. J Pediatr Surg. 2019;54(11):2195–9.PubMedCrossRef
40.
Sada A, Ubl DS, Thiels CA, Cronin PA, Dy BM, Lyden ML, et al. Optimizing opioid-prescribing practices after parathyroidectomy. J Surg Res. 2020;245:107–14.PubMedCrossRef
41.
Agamawi YM, Cass LM, Mouzourakis M, Pannu JS, Brinkmeier JV. Pediatric post-tonsillectomy opioid prescribing practices. Laryngoscope. 2021;131(6):1386–91.PubMedCrossRef
42.
Kirubalingam K, Nguyen P, Klar G, Dion JM, Campbell RJ, Beyea JA. Opioid Prescriptions following otologic surgery: a population-based study. Otolaryngol Head Neck Surg. 2022;167(1):141–8.
43.
Hadland SE, Cerda M, Li Y, Krieger MS, Marshall BDL. Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing. JAMA Intern Med. 2018;178(6):861–3.PubMedPubMedCentralCrossRef
44.
45.
Sites BD, Davis MA. Association of length of time spent in the united states with opioid use among first-generation immigrants. JAMA Network Open. 2019;2(10):e1913979-e.PubMedPubMedCentralCrossRef
46.
47.
Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am. 2005;23(1):21–36.PubMedCrossRef
48.
Oderda GM, Said Q, Evans RS, Stoddard GJ, Lloyd J, Jackson K, et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother. 2007;41(3):400–7.PubMedCrossRef
49.
Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77(5):1048–56.PubMed
50.
Clarke H, Poon M, Weinrib A, Katznelson R, Wentlandt K, Katz J. Preventive analgesia and novel strategies for the prevention of chronic post-surgical pain. Drugs. 2015;75(4):339–51.PubMedCrossRef
51.
Anne S, Mims JW, Tunkel DE, Rosenfeld RM, Boisoneau DS, Brenner MJ, et al. Clinical practice guideline: opioid prescribing for analgesia after common otolaryngology operations executive summary. Otolaryngol Head Neck Surg. 2021;164(4):687–703.PubMedCrossRef
Metadata
Title
Opioid versus non-opioid postoperative pain management in otolaryngology
Authors
Allison Keane
Kayla Jardine
David Goldenberg
Sandeep Pradhan
Jay Zhu
Jobran Mansour
Hadas Knoller
Ron Eshel
Yoav P. Talmi
Sonia Vaida
Guy Slonimsky
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02213-x

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