A Review of Postoperative Pain Management for Thyroid and Parathyroid Surgery

• Published in: The Journal of surgical research Vol. 241; pp. 107 - 111
• Main Authors: Uhlmann, Rebecca A., Reinhart, Henry A., Postevka, Eugene, Snyder, Samuel K., Romero Arenas, Minerva
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019
• Subjects: Analgesics, Opioid - adverse effects; Combined Modality Therapy - methods; Humans; Nonopioid adjuncts; Opioid abuse; Opioid epidemic; Opioid Epidemic - prevention & control; Pain Management - adverse effects; Pain Management - methods; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - therapy; Parathyroidectomy; Parathyroidectomy - adverse effects; Postoperative analgesia; Thyroidectomy; Thyroidectomy - adverse effects; Treatment Outcome; United States - epidemiology; United States; Nonopioid adjuncts; Parathyroidectomy; Thyroidectomy; Postoperative analgesia; Opioid epidemic; Opioid abuse
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2019.03.050

Perioperative opioid use has been linked to abuse potential by patients, leading surgeons to scrutinize their postoperative prescribing practices. The goal of the study was to review analgesic regimens for patients undergoing thyroidectomy and parathyroidectomy and extrapolate changes that could be made to decrease opioid use while maintaining adequate pain control. A literature review was performed. Inclusion criteria were studies 1) written in English, 2) published within the last 20 years, and 3) that included human subjects. Exclusion criteria were studies that 1) evaluated anesthesia regimens exclusively, 2) compared surgical approaches and their effects on pain (e.g., open neck exposure vs. transoral route for thyroidectomy), or 3) included patients undergoing concurrent lateral neck dissection. Of 951 studies originally identified, 10 studies met the criteria. Ten studies were identified, and each evaluated a different analgesic regimen. Five of the studies found a decrease in pain with multimodal regimens. Of the remaining studies, three found no difference in pain control, one found an increase in pain when only an opioid patient-controlled analgesia was used, and one found that 93% of patients required less than 20 oral morphine equivalents postoperatively. There is no postoperative analgesic regimen that has been established as optimal for patients undergoing parathyroidectomy and thyroidectomy in the current medical literature. However, half of the studies included in this review found that nonopioid adjuncts decreased patients’ need for postoperative opioids.