Multimodal analgesia after thyroid or parathyroid surgery: A randomized controlled trial

Background: The opioid epidemic prompted reevaluation of surgeons' opioid prescribing practices. This study aimed to demonstrate noninferiority of a staged analgesic regimen after endocrine surgery. Methods: We conducted a randomized controlled trial comparing analgesic regimens after thyroidectomy and/or parathyroidectomy. Adult patients ( 18 years) were randomized to study arm (A) as-needed acetaminophen + codeine or (B) scheduled acetaminophen/as-needed tramadol. Patients recorded pain scores and analgesics consumed in a study log. Clinical variables were collected from the medical record. Results: Target enrollment was achieved (n = 126), and randomization was even (A: 44.5%, B: 55.6%). There was no difference between enrolled patients and those who returned the study log (52.4%) by sex (P = .667), age (P = .513), final pathology (P = .137), procedure (P = .667), or randomization arm (P = .795). Most patients (50.8%) reported moderate pain scores (4-6) with no difference between study arms (P = .451). There was no difference in average consumption by morphine milligram equivalents (A: 11.5 +/- 12.1 vs B: 12.49 +/- 18.07; P =.792) nor total analgesic doses (A: 7.29 +/- 7.48 vs B: 8.5 +/- 5.36; P = .445). However, a significant difference in average percentage of opioid doses was noted (A: 79.71 +/- 33.31 vs B: 27.38 +/- 31.88; P < .001). Conclusion: Patients reported moderate pain scores with low requirements for analgesics after endocrine surgery. The staged analgesic regimen is noninferior to combination opioids and led to reduced overall consumption. (c) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study demonstrated that patients experienced moderate pain and had low analgesic requirements after endocrine surgery. The staged analgesic regimen was found to be noninferior to combination opioids and led to reduced overall consumption.