Use of Opioids in Patients With Thyroid Cancer After Extensive Neck Dissection
Posted: Thursday, March 12, 2020
According to a retrospective cohort study presented at the 2019 American Thyroid Association Annual Meeting (Abstract Poster 401) in Chicago and published in the journal Thyroid, patients with thyroid cancer who undergo extensive neck dissection during surgery require little to no opioid medication after the procedure. “These patients have relatively little postoperative pain that can be potentially controlled entirely with nonopioid medications,” concluded James Lim, MD, and Maisie Shindo, MD, both of Oregon Health and Science University. “Decreasing the volume of opioids prescribed at discharge will decrease waste and reduce [the] potential for addiction.”
The single-center study focused on 243 patients with thyroid cancer who were opioid-naive and who had undergone a lateral neck dissection during surgical treatment. More than half the patients were women (58.8%), the average age of patients was 47 years, and the total number of procedures undergone by the patient group was 273. Patients were organized into two groups based on when they had their procedure. Group 1 occurred between January 1, 2012, and January 31, 2017, prior to the institution of a change in prescribing practices. Group 2 occurred between February 1, 2017, and May 31, 2019. The measurement of the quantity of prescribed opioids was standardized by converting prescriptions and refills to morphine mg equivalents.
The mean prescribed morphine mg equivalent for group 1 was 295.40 versus 85.89 for group 2. The calculated effect size of the discrepancy between the two groups at 1.08. In group 2, 24 of 34 patients (70.5%) discharged in the last 8 months of the time frame were not prescribed any opioids at the time of release from care. In addition, no patients in group 2 requested opioid refills at any time in the last 8 months of this treatment window.
Disclosure: Full disclosures of the study authors can be found at thyroid.org.