Opioid-sparing regimen outperforms standard of care in oculoplastic pain control
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CHICAGO — Eliminating the use of opioids in the postoperative management of oculofacial surgery produced better pain control and subsequent patient satisfaction than standard of care regimens that included opioids, a presenter said here.
“Opioid-sparing therapy outperformed standard of care,” Monica M. Ray, MD, of TOC Eye and Face in Austin, Texas, said at the ASOPRS Fall Scientific Symposium.
Ray presented a study in which 20 participants in the study group underwent cosmetic surgery and agreed to the multimodal pain regimen while 20 participants in the control group, matched by age and procedure, received the standard opioid regimen. Patients with a history of substance use, who underwent revision surgery, or who were taking a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor were excluded.
“While less than 10% of postoperative patients who are prescribed opioids develop substance use disorder ... [after] undergoing elective cosmetic surgery, that’s still a very high number of patients,” Ray said. “And while we know our patients, the primary source of illegal prescription pain medications is actually from family and friends. ... We don’t necessarily know where the medications go after we prescribe them.”
Procedures included lower and upper blepharoplasty, endoscopic brow lift, lower face/neck lift and CO2 laser resurfacing. All patients were women, and the opioid-sparing group averaged 62.07 years of age and the standard of care group averaged 59.89 years of age.
The treatment group received acetaminophen (325 mg four times daily), gabapentin (300 mg three times daily), celecoxib (100 mg daily) and duloxetine (60 mg daily for 2 days) as well as tramadol (50 mg as needed every 6 hours) as a rescue medication.
Postoperatively, patients answered a detailed phone survey about their pain management experience: number of pills taken, ranking of pain immediately postoperatively as well in the days after surgery, types of pain and anxiety related to pain. The opioid-sparing group was surveyed an average of 45.05 days after surgery while the standard of care group was surveyed an average of 156.01 days after surgery (P < .01).
“We actually expected the recall bias to benefit the standard of care group since they were further out from surgery. However, they still rated their pain higher in the postoperative period,” Ray said.
The opioid-sparing group reported taking 4.36 narcotic pills after surgery while the standard of care group reported taking 10.2 (P < .01). Pain, ranked on a scale of 1 to 10, was similar on the night of surgery (5.29 vs. 5), but patients in the opioid-sparing group reported less pain the day after surgery than the standard of care group (4.93 vs. 7.17; P = .021) and 3 days after surgery (4.18 vs. 6.33; P < .01).
The study group ranked effectiveness of the pain protocols as 9.36 vs. 4.67 in the standard of care group (P < .01). Additionally, the opioid-sparing group rated anxiety as 2.71 vs. 5 in the standard of care group (P = .01).
“As health care providers, our job is always to decrease the risks of harm to our patients but also to society as a whole. This pain regimen also increased patient satisfaction and in their cosmetic surgery. Patient satisfaction and perception of their postoperative and perioperative period is incredibly important,” Ray said. “The other thing that it helps us to limit is the opioid prescriptions that we are able to prescribe to patients. We decrease the total number of opioid prescriptions we prescribe, decreasing the risk of those medications ending up outside of our patients’ hands. So overall, a general societal benefit and most importantly increasing patient satisfaction while decreasing potential harm.”
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Ray MM, et al. Opioid sparing vs. standard of care for post operative pain control in oculofacial plastic surgery. Presented at: ASOPRS Fall Scientific Symposium; Sept. 29-30, 2022; Chicago.
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