Pain control after plastic surgery

Are cosmetic surgeons fostering the opioid epidemic? (©FizkesNivens/Shutterstock.com)

According to two new studies, plastic surgery patients are at significant risk of persistent opioid use; plastic surgeons prescribe nearly double the number of opioid tablets consumed after outpatient procedures; and guidelines are needed to better balance under- and over-prescribing of opioids after plastic surgery procedures.
 
In one study published March 7, 2019, in JAMA Facial Plastic Surgery researchers studied persistent opioid use after plastic and reconstructive surgery procedures of the nose, eye, breast, abdomen and soft tissue in a population of about 467,000 patients. They found about half of those patients filled prescriptions for postoperative pain relievers and nearly all the prescriptions filled were for opioids.

The authors defined persistent opioid use as prescriptions filled 90 to 180 days after surgery. Persistent opioid use occurred in 6.6% of the study population, or 30,865 patients. Prolonged opioid use, which they defined as opioid prescriptions filled 90 to 180 days after surgery and then again 181 to 365 days after surgery, happened in 2.3% of the study population, or 10,487 patients.

Among the patients who were most likely to use opioids persistently or long term were those who filled prescriptions for the medications shortly before or after surgery. Breast and nasal procedure patients were most likely to use opioids persistently.

“It is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population,” the authors conclude.

When asked during a JAMA Facial Plastic Surgery Author Interview podcast why he did the study, author Sam P. Most, M.D., professor of Facial Plastic and Reconstructive Surgery at Stanford Hospital and Clinics, Stanford, Calif., said: “It’s in the news. It’s obvious that there’s a significant problem with opioid addiction in this country, and one of the root causes is thought to be patients becoming addicted to opioids after filling prescriptions for various procedures or other issues with pain. And we frankly wanted to know if as physicians we were in some ways making this worse.”

Plastic surgeons prescribe an average of 26 opioid tablets after outpatient plastic surgery procedures, but patients only consume an average 13, according to another study published March 2019 in Plastic and Reconstructive Surgery (PRS). 
The study of 170 patients found 80% percent of patients stopped opioids by five days after their procedures. Breast reduction and abdominoplasty patients consumed the most opioids, according to the authors.

Plastic surgeons need to strike a balance between under- and over-prescribing pain control medications, says PRS Editor-in-Chief Rod J. Rohrich, M.D., in a video commentary. 

Plastic surgeons might be overestimating patients’ pain control needs, according to Dr. Rohrich.