Effectiveness of non-opioid/non-narcotic postoperative pain management regimen for patients undergoing thyroidectomy and/or parathyroidectomy

Presentation: AHNS058
Topic: Quality of Care and Clinical Pathways
Type: Oral
Date: Thursday, April 19, 2018
Session: 3:30 PM - 4:30 PM Quality Engineering and Pathways
Authors: James R Biery, PAC, Phillip K Pellitteri, DO, FACS
Institution(s): Guthrie Clinic

Objective: To evaluate the effectiveness of a non-opioid/non-narcotic pain management regimen used to treat post operative pain in patients undergoing thyroidectomy and/or parathyroidectomy.

Materials and Methods: Patients undergoing thyroidectomy and/or parathyroidectomy preformed by our department during the time interval of April 2017 thru September 2017 receiving cutaneous injection with bupivacaine (0.5% bupivacaine hydrochloride with epinephrine, 1:200,000)  administered prior to incision, and discharged with oral acetaminophen and ibuprofen (ibuprofen added to regimen on postoperative day two) represented the study population. Response to pain management was evaluated using a scaled standard medical pain assessment tool via verbal questionnaire at patients postoperative visit, 7-10 days post procedure.

Results: In total, 76 procedures were performed over the study period (49 thyroidectomy, 27 parathyroidectomy). Three patients were excluded from the study (2 thyroidectomy, 1 parathyroidectomy) due to preoperative chronic opioid therapy for an unrelated diagnosis. 73 patients (47 thyroidectomy, 26 parathyroidectomy) were included in the study. Of these, only 1 required an oral opioid/narcotic prescription for post surgical pain (requested on postoperative day two). On follow up, the remaining 72 patients (98.3%) reported adequate pain control with the prescribed regimen, and required no opioid/narcotic supplementation.

Conclusions: Pre-incision cutaneous injection of bupivacaine, coupled with oral acetaminophen and ibuprofen, provides adequate pain control post operatively in patients undergoing thyroidectomy and/or parathyroidectomy, therefore avoiding opioid/narcotic supplementation.