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Perioperative analgesia for patients undergoing otologic surgery: An evidence-based review.

Abstract

OBJECTIVES/HYPOTHESIS

Opioid misuse and diversion is a major concern, with a negative impact on both the individual and society. The objective of this study was to perform an evidence-based systematic review of the efficacy of perioperative analgesic regimens following otologic surgery.

METHODS

Embase, Cochrane Library, and PubMed/MEDLINE databases (January 1, 1947 to June 30, 2018) were searched for studies investigating pain management in otologic surgeries. All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of surgery, medication class, dose, administration characteristics, pain scores, and adverse events were reported.

RESULTS

Twenty-three studies encompassing 1,842 patients met inclusion criteria. In 21.4% of studies, an overall reduction in pain scores was reported when the treatment group included more than one analgesic. Nausea and vomiting were the most common adverse events across all medication types (10.2%), with local anesthetic patients experiencing these side effects most frequently (38.0%). Perioperative acetaminophen was reported to have the fewest adverse drug reactions overall (6.1%), but did not reduce pain scores as much as other modalities, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics.

CONCLUSIONS

There is evidence that combination analgesics, such as acetaminophen plus codeine, provide superior pain relief to monotherapy analgesics in the perioperative pain management of otologic surgeries. NSAIDs, α-agonists, and nerve blocks may also be viable single-therapy options. Further prospective randomized controlled trials into perioperative analgesia for patients undergoing otologic surgery may be helpful in establishing a definitive consensus. Laryngoscope, 2019.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.Division of Pain Medicine, Department of Anesthesiology, Columbia University Medical Center, New York, New York.Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee. Department of Pediatric Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee. St. Jude Children's Research Hospital, Memphis, Tennessee, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30933321

Citation

Campbell, Hilary T., et al. "Perioperative Analgesia for Patients Undergoing Otologic Surgery: an Evidence-based Review." The Laryngoscope, 2019.
Campbell HT, Yuhan BT, Smith B, et al. Perioperative analgesia for patients undergoing otologic surgery: An evidence-based review. Laryngoscope. 2019.
Campbell, H. T., Yuhan, B. T., Smith, B., Misch, E., Svider, P. F., Pashkova, A. A., ... Johnson, A. P. (2019). Perioperative analgesia for patients undergoing otologic surgery: An evidence-based review. The Laryngoscope, doi:10.1002/lary.27872.
Campbell HT, et al. Perioperative Analgesia for Patients Undergoing Otologic Surgery: an Evidence-based Review. Laryngoscope. 2019 Apr 1; PubMed PMID: 30933321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative analgesia for patients undergoing otologic surgery: An evidence-based review. AU - Campbell,Hilary T, AU - Yuhan,Brian T, AU - Smith,Brendan, AU - Misch,Emily, AU - Svider,Peter F, AU - Pashkova,Anna A, AU - Sheyn,Anthony, AU - Ying,Yu-Lan M, AU - Johnson,Andrew P, Y1 - 2019/04/01/ PY - 2018/09/11/received PY - 2019/01/21/revised PY - 2019/01/28/accepted PY - 2019/4/2/entrez KW - Otologic surgery KW - otology KW - pain management KW - perioperative analgesia JF - The Laryngoscope JO - Laryngoscope N2 - OBJECTIVES/HYPOTHESIS: Opioid misuse and diversion is a major concern, with a negative impact on both the individual and society. The objective of this study was to perform an evidence-based systematic review of the efficacy of perioperative analgesic regimens following otologic surgery. METHODS: Embase, Cochrane Library, and PubMed/MEDLINE databases (January 1, 1947 to June 30, 2018) were searched for studies investigating pain management in otologic surgeries. All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of surgery, medication class, dose, administration characteristics, pain scores, and adverse events were reported. RESULTS: Twenty-three studies encompassing 1,842 patients met inclusion criteria. In 21.4% of studies, an overall reduction in pain scores was reported when the treatment group included more than one analgesic. Nausea and vomiting were the most common adverse events across all medication types (10.2%), with local anesthetic patients experiencing these side effects most frequently (38.0%). Perioperative acetaminophen was reported to have the fewest adverse drug reactions overall (6.1%), but did not reduce pain scores as much as other modalities, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics. CONCLUSIONS: There is evidence that combination analgesics, such as acetaminophen plus codeine, provide superior pain relief to monotherapy analgesics in the perioperative pain management of otologic surgeries. NSAIDs, α-agonists, and nerve blocks may also be viable single-therapy options. Further prospective randomized controlled trials into perioperative analgesia for patients undergoing otologic surgery may be helpful in establishing a definitive consensus. Laryngoscope, 2019. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/30933321/Perioperative_analgesia_for_patients_undergoing_otologic_surgery:_An_evidence-based_review L2 - https://doi.org/10.1002/lary.27872 DB - PRIME DP - Unbound Medicine ER -