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Multimodal Analgesia After Thyroid Or Parathyroid Surgery: A Randomized Controlled Trial
*Rebecca A Uhlmann1, Samuel K Snyder1, *Henry A Reinhart, III1, *Xiaohui Wang2, *Eugene Postevka1, *Minerva Romero Arenas1
1University of Texas Rio Grande Valley, Harlingen, TX;2University of Texas Rio Grande Valley, Edinburg, TX

Objective(s): The opioid epidemic in the United States has prompted surgeons to evaluate opioid prescribing practices. The goal of this study was to assess the use of opioid vs. non-opioid analgesics after thyroid or parathyroid surgery.
Methods: A randomized controlled trial was performed comparing analgesic regimens after thyroid or parathyroid surgery. Patients >18 years were randomized by birth year to receive acetaminophen with codeine (T3) as needed, or scheduled acetaminophen with tramadol as needed for breakthrough pain (A+T). Patients used a study log to note their level of pain from 0-10 and the amount of analgesics taken until their first postoperative visit.
Results: 115 patients were enrolled in the trial and randomized to T3 (n=51, 44%) or A+T (n=64, 56%). 65 of the 115 (56.5%) returned a study log and their charts were reviewed, of which 31 (47.7%) were randomized to T3 and 34 (52.3%) to A+T. Most patients (n=50, 76.9%) had thyroid surgery, while 11 (16.9%) had parathyroid surgery, and 4 (6.2%) had both. There was no difference in the average pain score between the T3 and A+T groups (5.44 vs. 5.19; p=0.66). The median pain score was 6 between and across groups. There was greater use of oral morphine equivalents (OMEs) in the A+T vs. T3 groups (23.13 vs. 11.98; p=0.03). The average OMEs used across both groups was 17.03. The median number of postoperative days when patients used their prescribed medication was 2 in the T3 group (range 0-9) vs. 3 in the A+T group (range 0-15).
Conclusions: Patients undergoing thyroid or parathyroid surgery reported low-to-moderate pain scores and required low amounts of analgesics post-operatively. The staged opioid analgesic regimen is non-inferior to combination opioid analgesics for pain management after thyroidectomy and parathyroidectomy. A staged opioid regimen may reduce OME consumption and decrease unnecessary patient exposure to opioids. Modification of prescribing practices by surgeons may help reduce the availability of opioids in the setting of the ongoing opioid epidemic.


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