A concise review of an importan publication in PRS Journal by Som et al, in March 2021.
Som, Avira B.S.; Santosa, Katherine B. M.D., M.S.; Skolnick, Gary B. B.S.; Lapidus, Jodi B. M.P.H.S.; Waljee, Jennifer F. M.D., M.P.H., M.S.; Patel, Kamlesh B. M.D., M.Sc. Plastic and Reconstructive Surgery: March 2021 - Volume 147 - Issue 3 - p 690-698 doi: 10.1097/PRS.0000000000007643
3 Sentence Summary
- ~1 in 2 patients will refill an opioid prescription, ~1 in 4 patients are inappropriately prescribed opioids, ~1 in 12 will have prolonged opioid used.
- Risk factors include late teens, and lots of fractures, in particular mandibular fractures.
- An enhanced recovery protocol can provide safe analgesia: bupivacaine nerve block, pregabalin, acetaminophen, opioid prescription with a 7-day limit.
3 Discussion Points
- Well-defined primary outcomes: "the primary outcome of our study was new persistent opioid use, defined as filling an opioid prescription between 60 to 180 days after surgery. Our second- ary outcome was the incidence of potentially inappropriate prescriptions."
- Large sample size (4829 patients) with solid collection of patient demographic data to allow for subgroup analysis and identification of confounders and clinical covariates.
- This data is representative of the general population of patients with this injury (majority are males, aged 15-17 years old with nasal fractures undergoing 1 procedure).
3 Ways to Change your Practice
- Early recognition of patients who are high risk for prolonged opioid use (males, late teens, multiple fractures or mandibular fracture)
- Educate your team about alternative safe medication options and enhanced recovery protocols.
- Audit your practice on opioid prescribing and see where there are areas to improve.
3 Recommended Articles
- Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016;170:1195–1201.
- Scully RE, Schoenfeld AJ, Jiang W, et al. Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA Surg. 2018;153:37–43.
- Ahiskalioglu A, İnce İ, Aksoy M, Yalcin E, Ahiskalioglu EO, Kilinc A. Effects of a single-dose of pre-emptive pregabalin on postoperative pain and opioid consumption after double- jaw surgery: A randomized controlled trial. J Oral Maxillofac Surg. 2016;74:53.e1–53.e7.