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Opioid Stewardship in Otolaryngology: State of the Art Review.
Otolaryngol Head Neck Surg. 2018 05; 158(5):817-827.OH

Abstract

Objective The United States is facing an epidemic of opioid addiction. Deaths from opioid overdose have quadrupled in the past 15 years and now surpass annual deaths during the height of the human immunodeficiency virus epidemic. There is a link between opioid prescriptions after surgery, opioid misuse, opioid diversion, and use of other drugs of abuse. As surgeons, otolaryngologists contribute to this crisis. Our objective is to outline the risk of abuse from opioids in the management of acute postoperative pain in otolaryngology-head and neck surgery (OHNS) and strategies to avoid misuse. Data Sources PubMed/MEDLINE. Review Methods We conducted a review of the literature on the rate of opioid abuse after surgery, methods of safe opioid use, and strategies to minimize the dangers of opioids. Conclusions Otolaryngologists have a responsibility to treat pain. This begins preoperatively by discussing perioperative pain control and developing a personalized pain control plan. Patients should be aware that opioids carry significant risks of adverse events and abuse. Perioperative use of multimodal nonopioid agents enables pain control and avoidance of opioids in many otolaryngologic cases. When this approach is inadequate, opioids should be used in short duration under close surveillance. Institutional standards for opioid prescribing after common procedures can minimize misuse. Implications for Practice Otolaryngologists need to acknowledge the potential harm that opioids cause. It is essential that we evaluate our practices to ensure that opioids are used responsibly. Furthermore, opioid stewardship should become a priority in otolaryngology.

Authors+Show Affiliations

1 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.2 Department of Anesthesiology, United States Air Force, Wright Patterson Air Force Base, Dayton, Ohio, USA.3 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29437536

Citation

Cramer, John D., et al. "Opioid Stewardship in Otolaryngology: State of the Art Review." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 158, no. 5, 2018, pp. 817-827.
Cramer JD, Wisler B, Gouveia CJ. Opioid Stewardship in Otolaryngology: State of the Art Review. Otolaryngol Head Neck Surg. 2018;158(5):817-827.
Cramer, J. D., Wisler, B., & Gouveia, C. J. (2018). Opioid Stewardship in Otolaryngology: State of the Art Review. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 158(5), 817-827. https://doi.org/10.1177/0194599818757999
Cramer JD, Wisler B, Gouveia CJ. Opioid Stewardship in Otolaryngology: State of the Art Review. Otolaryngol Head Neck Surg. 2018;158(5):817-827. PubMed PMID: 29437536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid Stewardship in Otolaryngology: State of the Art Review. AU - Cramer,John D, AU - Wisler,Brad, AU - Gouveia,Christopher J, Y1 - 2018/02/13/ PY - 2018/2/14/pubmed PY - 2019/9/21/medline PY - 2018/2/14/entrez KW - analgesics KW - head and neck surgery KW - narcotics KW - opioids KW - otolaryngology KW - pain KW - postoperative pain SP - 817 EP - 827 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 158 IS - 5 N2 - Objective The United States is facing an epidemic of opioid addiction. Deaths from opioid overdose have quadrupled in the past 15 years and now surpass annual deaths during the height of the human immunodeficiency virus epidemic. There is a link between opioid prescriptions after surgery, opioid misuse, opioid diversion, and use of other drugs of abuse. As surgeons, otolaryngologists contribute to this crisis. Our objective is to outline the risk of abuse from opioids in the management of acute postoperative pain in otolaryngology-head and neck surgery (OHNS) and strategies to avoid misuse. Data Sources PubMed/MEDLINE. Review Methods We conducted a review of the literature on the rate of opioid abuse after surgery, methods of safe opioid use, and strategies to minimize the dangers of opioids. Conclusions Otolaryngologists have a responsibility to treat pain. This begins preoperatively by discussing perioperative pain control and developing a personalized pain control plan. Patients should be aware that opioids carry significant risks of adverse events and abuse. Perioperative use of multimodal nonopioid agents enables pain control and avoidance of opioids in many otolaryngologic cases. When this approach is inadequate, opioids should be used in short duration under close surveillance. Institutional standards for opioid prescribing after common procedures can minimize misuse. Implications for Practice Otolaryngologists need to acknowledge the potential harm that opioids cause. It is essential that we evaluate our practices to ensure that opioids are used responsibly. Furthermore, opioid stewardship should become a priority in otolaryngology. SN - 1097-6817 UR - https://neuro.unboundmedicine.com/medline/citation/29437536/Opioid_Stewardship_in_Otolaryngology:_State_of_the_Art_Review_ DB - PRIME DP - Unbound Medicine ER -