Retrospective Cohort Study of Ibuprofen Based Pain Regimen to Reduce
Postoperative Opioid Use in Adult Tonsillectomy
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 New Mexico
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.