Postoperative opioid use following head and neck endocrine surgery: A multi-center prospective study.

BACKGROUND

Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia.

METHODS

Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans.

RESULTS

A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling ( = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%,  < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%,  < .05). Patients who received local anesthesia peri-operatively (46.4%,  = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19),  < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8),  < .05].

CONCLUSION

Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction.

LEVEL OF EVIDENCE

Level 3.