David E. Tunkel, MD, discusses opioid prescribing for analgesia after common otolaryngology operations.
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Pediatric otolaryngologist Dr. David Tunkel from @hopkins_ent and @HopkinsKids discusses guidelines for prescribing opioids to control pain after common otolaryngology surgeries. Click to Tweet
I'm Dr. David Tunggal. I'm the director of pediatric otolaryngology at JohNS Hopkins. I'm also one of the lead authors of a clinical practice guideline that was developed by the American Academy of Otolaryngology, head and neck surgery on the prescribing of opioids to control pain. After common otolaryngologist surgery. The epidemic of opioid abuse and overdose is front and center in our headlines and the medical community is now developing strategies to line the need for appropriate pain control after surgery while also reducing risk from any prescribed opioids is important to look at the prescribing practices for treatment of acute postoperative pain. As surgeons are second only to pain specialists in the number of opioid prescriptions written, we know that a significant number of patients who are prescribed opioids after surgery will continue the use of such drugs well after surgery and the patients who are at risk for opioid use disorder can often be identified before the surgery. Otolaryngologist wrote nearly one million days of Opioid scripts for Medicare patients in 2015. Given this crisis of opioid misuse, diversion addiction and overdose. The american Academy of Otolaryngology. Head neck surgery, developed with an expedited timeline, a clinical practice guideline that focused on opioid prescribing after common TNT procedures. This guideline has action statements that provide guidance to the clinician reader. The opioid guideline provides recommendations about the expected levels and duration of pain after specific kinds of E. N. T. Operations and details some of the modifying patient factors that might change pain experience as well as the type of pain management needed. The emphasis is on identifying patients who may be at risk for opioid use disorder, as well as encouraging the use of multimodal therapy that includes non opioid medications such as acetaminophen and nonsteroidal anti inflammatory drugs. When opioids are necessary, they should be used at the lowest effective dose and for the shortest duration needed. Additionally, the clinician should educate patients about when to stop opioid medications, how to report problems with pain management, how to safely store opioids in the household to prevent diversion, how to dispose of medications when no longer used. This clinical practice guideline contains several helpful tables. Here is a table that details the expected duration of pain and the severity of pain after different otolaryngology procedures. Not surprisingly, pharyngeal procedures such as tonsillectomy are associated with the most severe pain of longest duration, but perhaps more surprising, some procedures on the neck cause mild pain of short duration. So there are predictable features of our surgical procedures that can guide the need to prescribe opioids at least initially. A concept that was certainly new to this surgeon, author and advanced strongly by our guideline development group, was the need to counsel patients about how to securely store the prescribed opioids to avoid misuse and diversion to others in the household. Additionally, the recommendations made to counsel patients about how to dispose of unused doses of opioids when pain is either gone or it can be controlled by non opioid medications. The guideline also contains educational materials for clinicians and their patients, including instruments for assessment of the patient's opioid use, disorder, risk and lists of frequently asked questions about postoperative pain management. I encourage you to read the recommendations in this clinical practice guideline and adopt them in your practice setting. There's a plain language summary that provides information to patients and consumers to assist and shared decision making about pain control between the surgical patient and the surgeon. These guidelines are available for download at E N T net dot org. And this specialty specific guideline was just published in the april 2021 edition of otolaryngology, head neck surgery. Thank you.
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