Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery

Objective To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS). Study Design Case series with planned data collection. Setting Tertiary referral medical center. Subjects and Methods We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7. Results A total of 64 patients completed surveys. Mean +/- SD narcotic use over the 7-day postoperative period was 7.7 +/- 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (<= 6 pills) but did report a higher level of postoperative day 1 pain (4.8 +/- 1.1 vs 2.0 +/- 1.4, P < .001). Narcotic use declined during this period, with Conclusion Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.