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Opioid Use by Patients After Rhinoplasty

Educational Objective
To understand the role that overprescription of narcotics has played in the opioid crisis, and to consider modification of prescribing practices for pain management in rhinoplasty patients.
1 Credit CME
Key Points

Question  How many of the initially prescribed 20 to 30 tablets of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) do patients consume after rhinoplasty?

Findings  In this case series, 62 patients consumed a mean of 9 of 20 to 30 prescribed combination hydrocodone-acetaminophen tablets after undergoing rhinoplasty, meaning that 15 hydrocodone-acetaminophen tablets are sufficient to control pain in 74% of patients undergoing a similar procedure.

Meaning  To mitigate the misuse or diversion of physician-prescribed opioid medications, surgeons must be steadfast in prescribing an appropriate amount of pain medication after surgery, which requires communication, research, and planning.

Abstract

Importance  Given the increase in opioid addiction and overdose in the United States, reasoned opioid use after outpatient surgery may affect prescription medication abuse.

Objectives  To examine patient use of opioids after rhinoplasty and establish an optimal postrhinoplasty pain management regimen.

Design, Setting, and Participants  In this case series, opioid use was evaluated in 62 patients who underwent rhinoplasty performed by 3 fellowship-trained facial plastic surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016.

Main Outcomes and Measures  Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed.

Results  The mean (SEM) age of the patients was 38.7 (16.4) years and included 50 female patients (81%). Of the initially prescribed 20 to 30 hydrocodone-acetaminophen combination tablets, the 62 patients included in this study used a mean (SEM) of 8.7 (0.9) tablets, only 40% of those prescribed after rhinoplasty. In addition, 46 patients (74%) consumed 15 or fewer tablets, whereas only 3 patients (5%) required refills of pain medication. Sex, age, concurrent septoplasty or turbinate reduction, use of osteotomy, and history of a rhinoplasty were not associated with the number of tablets used. The most common adverse effects included drowsiness in 22 patients (35%), nausea in 7 (11%), light-headedness in 3 (5%), and constipation in 3 (5%).

Conclusions and Relevance  To mitigate the misuse or diversion of physician-prescribed opioid medications, surgeons must be steadfast in prescribing an appropriate amount of pain medication after surgery. A multifaceted pain control program is proposed to manage postoperative pain and ascertain the balance between controlling pain and avoiding overprescribing narcotics.

Level of Evidence  NA.

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Article Information

Corresponding Author: Russell Kridel, MD, Facial Plastic Surgery Associates, 6655 Travis St, Ste 900, Houston, TX 77030 (rkridel@todaysface.com).

Accepted for Publication: May 15, 2017.

Published Online: November 9, 2017. doi:10.1001/jamafacial.2017.1034

Author Contributions: Drs Patel and Bobian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Patel, Sturm, Svider, Zuliani, Kridel.

Acquisition, analysis, or interpretation of data: Patel, Sturm, Bobian, Svider, Zuliani, Kridel.

Drafting of the manuscript: Patel, Bobian.

Critical revision of the manuscript for important intellectual content: Patel, Sturm, Bobian, Svider, Zuliani, Kridel.

Statistical analysis: Patel, Bobian, Svider.

Obtained funding: Patel.

Administrative, technical, or material support: Patel, Kridel.

Study supervision: Patel, Sturm, Zuliani, Kridel.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Patrice Harris, MD, MA, Department of Psychiatry and Behavioral Health, Emory University School of Medicine, Atlanta, Georgia, provided thoughtful insight and review of the paper. The National Alliance for Model State Drug Laws and Sherry L. Green & Associates, LLC, contributed the Prescription Drug Monitoring Programs state maps and compilation of state laws. Amanda Schobel and Sue Marsh, Facial Plastic Surgery Associates, Houston, Texas, designed the figures. No one received financial compensation for the stated contribution.

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