Opioid Prescribing vs Consumption Following Rhinoplasty

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The researchers concluded that "given the opioid epidemic crisis, it is the responsibility of the surgeon to prescribe opioids with caution and purpose."
The researchers concluded that "given the opioid epidemic crisis, it is the responsibility of the surgeon to prescribe opioids with caution and purpose."

Patients used only 40% of the hydrocodone-acetaminophen combination tablets prescribed to them following rhinoplasty, and only 5% of patients required refills of pain medication, according to a study recently published in JAMA Facial Plastic Surgery.

In this case series, researchers enrolled 62 patients (mean age, 38.7; 81% women) who underwent rhinoplasty in 2 private practice settings and 1 academic setting. All patients received prescriptions of 20 to 30 hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) combination tablets. Opioid use, pain control, and adverse effects were self-reported. Surgical techniques and characteristics of each surgery were evaluated by reviewing medical records.

The mean number of hydrocodone-acetaminophen tablets consumed was 8.7 (standard error of the mean [SEM], 0.9). Of the 1490 tablets prescribed overall, 541 tablets (36.3%) were used. In addition, 74% of patients used 15 or fewer tablets, and 15% of patients did not use pain medication at all. No correlation was reported between tablet use and age, sex, primary vs revision procedures, cosmetic vs functional procedures, osteotomy, septoplasty, or turbinate reduction.

Adverse events included drowsiness (35%), nausea (11%), lightheadedness (5%), and constipation (5%). A total of 38% of patients used acetaminophen after they discontinued the hydrocodone-acetaminophen.

The study investigators explained that their results support past analyses, "[elucidating] a problem that surgeons encounter because patients may experience and respond to pain and opioids differently… Surgeons typically address this problem by standardizing their prescribing regimen for an outlier patient who would require the maximum dosage; thus, they typically overprescribe." They concluded that "given the opioid epidemic crisis, it is the responsibility of the surgeon to prescribe opioids with caution and purpose."

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Reference

Patel S, Sturm A, Bobian M, et al. Opioid Use by Patients After Rhinoplasty [published online November 9, 2017]. JAMA Facial Plast Surg. doi:10.1001/jamafacial.2017.1034

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