Militsakh O, et al. - Authors observed the trends in adoption and adherence to institutional multimodal analgesia (MMA) protocols following thyroid and parathyroid surgery. They also evaluated the correlation of institutional multimodal (nonopioid) analgesia protocols with opioid use and physician prescribing patterns after outpatient thyroid and parathyroid surgery. Over the study period, they noted a correlation between substantial increase in adoption and adherence to the MMA protocol for patients undergoing thyroid and parathyroid surgery and a simultaneous significant decline in prescription of postoperative opioid analgesics. Findings suggested safety of the use of nonopioid multimodal agents, incorporating NSAIDs and it did not lead to increased incidence of bleeding. Physician prescribing practices may be influenced favorably and unnecessary opioid prescriptions may be avoided with the availability of effective nonopioid MMA pathways.

Methods

• Experts conducted a cohort study at a head and neck surgery service at a tertiary care hospital of prescription patterns and retrospective review of patient medical records following implementation of an optional institutional MMA protocol in 2015, based on preoperative administration of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentin, and postoperative use of acetaminophen and ibuprofen for analgesia after thyroid and parathyroid surgery.
• Thyroid and parathyroid surgery was conducted in 528 adult patients between January 1, 2015, and June 30, 2017.
• They reported on adherence to the MMA protocol over the study period as measure of physician buy-in and adoption of the technique.
• Over the study period, the frequency of opioid use and physician prescription patterns following thyroid and parathyroid surgery is reported to study the relationship of the available MMA pathway with these variables.

Results

• Findings suggested that a total of 528 patients (mean [SD] age, 53.1 [15.7] years; 80.3% female) had outpatient thyroid and parathyroid surgery.
• During the study period, the frequency of postoperative opioid prescriptions decreased (16 of 122 [13.1%] in 2015, 22 of 244 [9.0%] in 2016, 3 of 162 [1.9%] in 2017).
• As per data, adherence to the MMA protocol increased (0 of 122 cases in 2015, 106 of 244 [43.4%] cases in 2016, 142 of 162 [87.7%] cases in 2017), with reduced likelihood of opioid prescription on discharge (2017 vs 2015 odds ratio, 0.13; 95% CI, 0.04-0.44).
• In the study cohort, only 1 postoperative hematoma was recorded, and same-day discharge was achieved by 352 (66.7%) patients, whereas 176 (33.3%) maintained outpatient status but received overnight observation prior to discharge.