Opioid prescription for post operative pain management in ENT: AAO guidelines

Opioid use disorder (OUD), which includes misuse, abuse, and overdose of opioids, is an epidemic in the United States. According to data from the National Survey on Drug Use and Health, more than six million people ages 12 or older misuse prescription pain relievers in a given year in the United States. Additionally, studies have shown that there is a significant risk of chronic opioid use even when used as short-term treatment for pain.

This specialty-specific guideline provides evidence-based recommendations on postoperative management for pain in common otolaryngologic procedures, with a focus on opioids. The guideline addresses assessment of patients 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 responsible use of opioids. In addition, the guideline highlights quality improvement opportunities in postoperative pain management of common otolaryngologic surgeries.

The key highlights have been summerised below.

• STATEMENT 1. EXPECTED PAIN: Prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain.
• STATEMENT 2. MODIFYING FACTORS: Prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain
• STATEMENT 3A. RISK FACTORS FOR OPIOID USE DISORDER: Prior to surgery, clinicians should identify risk factors for OUD when analgesia using opioids is anticipated. (Strong recommendation)
• STATEMENT 3B. PATIENTS AT RISK FOR OPIOID USE DISORDER: In patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan.
• STATEMENT 4. 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.
• STATEMENT 5. MULTIMODAL THERAPY: Clinicians should develop a multimodal treatment plan for managing postoperative pain.
• STATEMENT 6. NONOPIOID ANALGESIA: Clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery. (Strong recommendation)
• STATEMENT 7. OPIOID PRESCRIBING: When treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration.
• STATEMENT 8A. PATIENT FEEDBACK: Clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur.
• STATEMENT 8B. 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.
• STATEMENT 9. 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. (Strong recommendation)
• STATEMENT 10. 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.

Employing the key action statements from this clinical practice guideline (CPG) can help to reduce the variation in care across the specialty of otolaryngology and improve postoperative pain control while reducing the risk of OUD.

"As otolaryngologist-head and neck surgeons, we can help reduce the risk of opioid use disorder among our patients and their families," said Samantha Anne, MD, MS, Chair of the Guideline Development Group (GDG). "This clinical practice guideline focuses on multimodal analgesia and judicious use of opioids for common otolaryngology procedures."

Primary source: Otolaryngology-Head and Neck Surgery

For full text follow the link:https://journals.sagepub.com/doi/10.1177/0194599821996297