In a study of rhinoplasty patients’ postsurgery opioid use, facial plastic surgeons found they could prescribe fewer pain pills than they thought were necessary.
“With the current crisis, it is imperative for all physicians — particularly, surgeons — to prescribe opioids responsibly and conscientiously,” says study author Angela Sturm, M.D., who is in private practice in Houston, Texas. “As surgeons who perform cosmetic and elective surgeries, we have the ability to properly asses, monitor and limit excessive pain medication requirements in a very motivated patient population. By not over-prescribing opioid pain medications, we make less available for diversion and misuse.”
In the study, three fellowship trained facial plastic surgeons reported on a 2016 case series of opioid use in 62 patients post rhinoplasty. The average age of the patients was 38.7 and 81% were female. The surgeons initially guessed on the number of pills needed, prescribing 20 to 30 hydrocodone-acetaminophen combination tablets to each patient.
Based on their findings, they’ve since decreased their opioid prescribing patterns for rhinoplasty patients, according to the study.
They found that nearly 64% of the prescribed pain medication went unused, with the 62 patients consuming an average of nine of the 20 to 30 combination tablets after rhinoplasty. As a result, they write, 15 hydrocodone-acetaminophen tablets would have been enough to adequately control pain in 74% of the patients. Five percent, or three, of the patients studied required a pain medication prescription refill.
According to the paper, these facial plastic surgeons now prescribe a standard 15 opioid tablets to their rhinoplasty patients.
The number of tablets consumed didn’t appear to be associated with patient age, gender, concurrent septoplasty or turbinate reduction, use of osteotomy or rhinoplasty history, according to the study.
However, among rhinoplasty surgeries, procedures that include conchal cartilage harvest or rib harvest are ones that are likely to require more pain medications compared to primary rhinoplasties, according to Dr. Sturm.
The authors propose a multifaceted pain control program for optimal postoperative pain management and to avoid narcotic overprescribing. The program includes preoperative and postoperative assessments.
“As surgeons, we should take into consideration pain control by the use of multiple modalities and limitation of use of potentially painful techniques, like not using hard intranasal splints that are not scientifically shown to be advantageous,” Dr. Sturm says. “Also, we should be vigilant in conducting a detailed preoperative assessment of the patient and discussion of pain management focused on the surgical plan for that patient. The surgeon should discuss the patient’s previous experience with pain medications, prior operations, injuries, other procedures for which they may have used pain medications. In addition, each physician should review of the state prescription drug monitoring program (PDMP) database prior to prescribing opioid pain medications.”
Responsible opioid prescribing is the surgeon’s responsibility and a team effort, involving prescriber, clinical staff and patient communication, the authors write.