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      No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol

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          Abstract

          Supplemental Digital Content is available in the text.

          Background:

          From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public.

          Methods:

          A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients.

          Results:

          Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3–81), and median total requirement was 20 mg morphine equivalents (range 7.5–85). Protocol compliance inversely correlated to opioid use ( P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1–5 ( P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups.

          Conclusion:

          This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction.

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          Most cited references46

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          The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

          Annual Review of Public Health, 36(1), 559-574
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            Pain: a review of three commonly used pain rating scales.

            This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.
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              New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults.

              Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2169-7574
                December 2020
                21 December 2020
                : 8
                : 12
                : e3305
                Affiliations
                [* ]Department of Surgery, University of Nebraska Medical Center, Omaha, Nebr.
                []Department of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Nebr.
                []The Craniofacial Center, Dallas, Tex.
                [§ ]College of Medicine, University of Nebraska Medical Center, Omaha, Nebr.
                []Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebr.
                []Department of Biostatistics, College of Public health, University of Nebraska Medical Center, Omaha, Nebr.
                Author notes
                Perry J. Johnson, MD, Department of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, E-mail: pjjohnson@ 123456unmc.edu
                Article
                00014
                10.1097/GOX.0000000000003305
                7787342
                a643ac29-8d7d-4c87-bcef-d95106489118
                Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 24 August 2020
                : 9 October 2020
                Categories
                Cosmetic
                Original Article
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