BACKGROUND
The opioid epidemic is real. While these drugs can be very useful in controlling pain, they are well known to be habit- forming, and some patients are unable to stop their use when the pain is no longer an issue. Physicians contribute to the epidemic by prescribing opioids after most surgical procedures, though in reality, many patients do not use the opioids and they are likely unnecessary. Thyroid and parathyroid surgery are generally well-tolerated procedures with very little discomfort from the actual incision itself in the post-operative period. Though many endocrine surgeons are already not prescribing narcotics, there have been no studies to date that specifically measured opioid use after thyroid surgery. In this study, the authors counseled patients on possible opioid use before surgery and then let the patients decided if they needed it. The amount of opioid use was measured in patients that chose these drugs.

THE FULL ARTICLE TITLE
Ruffolo LI et al2019 Narcotic free cervical endocrine surgery: a shift in paradigm. Ann Surg. Epub 2019 July 6. PMID: 31356280.

SUMMARY OF THE STUDY
Over 200 patients at a single institution were counseled before surgery that they could choose to receive narcotics or not after thyroid surgery. They were compared with 100 prior patients at the same institution that did get narcotics. Thyroid, parathyroid, and neck dissections were all included. Less than 5% of patients chose to receive opioids after surgery. Of the >95% of patients that did not choose opioids, none requested a prescription late in the post-operative period or reported pain. Of those that choose opioids, on average, 8 pills were consumed per patients; more than half were chronic pain patients or had baseline narcotic use.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Very few patients need narcotics after head and neck surgery, except for those on baseline narcotics or with chronic pain. Narcotics should not routinely be prescribed to patients after thyroid and parathyroid surgery unless they request it.

— Melanie Goldfarb, MD, FACS

Table of Contents | PDF File for Saving and Printing