Prospective Randomized Trial Comparing Opioids versus Nonsteroidal Antiinflammatory Drugs for Postoperative Analgesia in Outpatient Rhinoplasty
| Autor: | Jeffrey D Markey, Binhuan Wang, Marissa P. Lafer, Anna Frants, Judy W. Lee, David Garber, Steven A. Gordon, Yan Zhang |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Analgesic 030230 surgery law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Statistical significance medicine Humans Prospective Studies Opioid Epidemic Adverse effect Pain Measurement Pain Postoperative business.industry Anti-Inflammatory Agents Non-Steroidal Opioid-Related Disorders Rhinoplasty Ibuprofen Acetaminophen Analgesics Opioid Treatment Outcome Ambulatory Surgical Procedures Hydrocodone Opioid 030220 oncology & carcinogenesis Anesthesia Female Surgery Analgesia business medicine.drug |
| Zdroj: | Plastic & Reconstructive Surgery. 147:56-62 |
| ISSN: | 0032-1052 |
| DOI: | 10.1097/prs.0000000000007427 |
| Popis: | Background The misuse and abuse of opioids, including overprescription, has led to the current opioid epidemic and national crisis. There is a national effort to eliminate the unnecessary prescription of opioids for analgesia. Methods Seventy patients were randomized to receive postoperative analgesia with either 5 mg hydrocodone with 325 mg acetaminophen (opioid control group) or 400 mg of ibuprofen [nonsteroidal antiinflammatory drug (NSAID) experimental group]. Pain levels were assessed on postoperative days 1, 2, and 7. Outcome measures included numeric pain rating scores and assessments of frequency and amount of analgesic used. Results There was no significant difference in gender (p = 0.81) or age (p = 0.61) between groups. On postoperative day 0, the NSAID group (mean ± SD, 2.54 ± 1.57) was found to be noninferior to the opioid group (mean ± SD, 3.14 ± 1.75; p = 0.003). On postoperative day 1, the NSAID group showed a lower mean pain score (mean ± SD, 1.84 ± 1.29) than the opioid group (mean ± SD, 2.46 ± 1.90; p = 0.01). However, on postoperative day 7, the difference in pain scores between the NSAID (mean ± SD, 3.29 ± 2.14) and opioid (mean ± SD, 3.14 ± 2.12; p = 0.17) groups lost statistical significance. There was no significant difference in mean day of medication cessation between the NSAID (mean ± SD, 4.73 ± 1.57) and opioid (mean ± SD, 4.28 ± 2.23; p = 0.26) groups. Seventy-six percent of patients who were prescribed opioids took fewer than eight tablets. Five patients escalated from NSAIDs to opioids. There were no adverse effects related to NSAID use. Conclusions NSAIDs are an acceptable and safe alternative to opioids for postoperative analgesia in rhinoplasty and potentially lead to better overall pain control in some patients. Significantly reducing or eliminating opioid prescriptions may be considered in light of the current opioid epidemic. Clinical question/level of evidence Therapeutic, II. |
| Databáze: | OpenAIRE |
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