Abstract
Objectives: Quantify the effect of a non-opioid pain regimen on
postoperative opioid prescriptions filled by the patient after adult
tonsillectomy.
Design : Retrospective cohort study including a time frame
before and after a practice change from an opioid/acetaminophen-based
postoperative pain regimen to a regimen based on ibuprofen and
acetaminophen. Half of study subjects received a prescription for
postoperative opioid medications. Half were prescribed ibuprofen
following surgery and only provided with opioid analgesia as a rescue
medication, where ibuprofen was medically contraindicated, or at patient
request following counseling regarding risks of opioids. The BLINDED FOR
REVIEW Prescription Monitoring System was used to verify filled opioid
prescriptions. Descriptive statistics and logistic regression were used
for data analysis.
Settings : Tertiary care academic medical center.
Participants: All elective adult tonsillectomies performed
consecutively by a single surgeon.
Main Outcome Measures : Percent of patients filling an opioid
prescription.
Results: Ninety-nine patients were included in analysis. 53
received an opioid-based postoperative regimen and 46 received an
ibuprofen/acetaminophen-based regimen. There was no difference in the
bleeding rate between the two groups. Significantly fewer patients in
the ibuprofen group filled postoperative opioid prescriptions when
compared to the group that did not receive ibuprofen (40% vs. 96.2%,
p<0.0001, OR=0.02).
Conclusion: Ibuprofen is a safe and effective analgesic
following adult tonsillectomy and significantly reduces the proportion
of patients who fill a postoperative opioid prescription.
Keywords: evidence based medicine, outcomes, tonsillectomy,
Health services research, pharmacology