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Most patients can achieve sufficient pain relief with nonopioid analgesics after otologic surgery, reducing the need for opioid prescriptions.
A retrospective multicenter cohort study suggests that nonopioid analgesics, such as acetaminophen (paracetamol) and ibuprofen, offer adequate pain amelioration for the majority of patients undergoing middle ear and mastoid surgery. Conducted at two quaternary academic medical centers, the study challenges the routine use of opioid prescriptions for postoperative pain management in otologic procedures. Researchers analyzed data from 67 patients (above 12 years) who underwent various types of otologic surgery over a five-month period. These included:
Postoperatively, all patients were prescribed acetaminophen and ibuprofen for pain relief and were instructed to contact the surgical team if additional pain management was needed. If their pain remained uncontrolled, opioid analgesics were administered. Pain levels and medication use were examined via a standardized questionnaire 1 week following surgery. Postoperative pain intensity during the first week (rated 0-10) and the percentage of patients needing opioid medication were the primary outcomes ascertained.
Throughout the first postoperative week, participants reported a median average pain score of 5/10 (IQR 3-6), with peak pain levels reaching a median of 5/10 (IQR 4-8). By the end of the week, pain had subsided to a median of 3/10 (IQR 1-5). Only 10% (7 patients) required opioid medication for breakthrough pain, while the vast majority—90%—managed solely with nonopioid analgesics. At the 1-week mark, 60% continued using nonopioid analgesics, whereas 40% had discontinued pain medication entirely. Despite occasional opioid use, medication patterns remained consistent across both medical centers.
Thus, nonopioid analgesics are useful for most patients following otologic surgery, markedly minimizing the need for opioid prescriptions. Given that only 10% of patients required opioid rescue medication, the study supports a shift away from routine opioid prescribing for middle ear and mastoid surgery. These results align with broader efforts to minimize opioid use in postoperative pain care while ensuring adequate pain control. This study reinforces the role of acetaminophen and ibuprofen as primary analgesics after otologic procedures, potentially alleviating opioid exposure and associated risks such as dependence and side effects.
Otology & Neurotology
Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?
Mustafa G Bulbul et al.
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