Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?

Abstract

Objective: Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.

Study design: Retrospective multicenter cohort.

Setting: Two quaternary academic medical centers.

Patients: Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.

Interventions: Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.

Main outcome measures: Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication.

Results: Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.

Conclusions: NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.