Development of MMA pathways in outpatient thyroid and parathyroid surgery and association with postop opioid prescription patterns

A recent study sought to assess trends in adoption and adherence to institutional multimodal analgesia (MMA) protocols after thyroid and parathyroid surgery.

A recent study sought to assess trends in adoption and adherence to institutional multimodal analgesia (MMA) protocols after thyroid and parathyroid surgery. Additionally, the team from Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, examined the association of institutional multimodal (nonopioid) analgesia protocols with opioid use and physician prescribing patterns following these surgeries. While MMA has demonstrated efficacy in controlling postoperative pain in patients undergoing some other kinds of surgery, concerns about use of NSAIDs and a perceived fear of bleeding or hematoma have limited their use in head and neck surgery. The cohort study involved more than 500 adults who underwent thyroid and parathyroid surgery between 2015 and 2017. According to the data, the frequency of postoperative opioid prescriptions dropped to 1.9% in 2017, down from 13.1% in 2015. In addition, adherence to the MMA protocol rose from none of 122 cases in 2015 to 87.7% of 162 cases in 2017. The likelihood of an opioid prescription on discharge decreased, meanwhile. In all, only one postoperative hematoma was recorded—and this patient was found to have been involved in a high-speed motor vehicle collision prior to returning to the hospital with a neck hematoma. For individuals undergoing thyroid and parathyroid surgery, adoption and adherence to an MMA protocol increased over the study period and was linked to a reduction in the prescription of opioids after surgery. "Availability of effective nonopioid MMA pathways may favorably influence physician prescribing practices and avoid unnecessary opioid prescriptions," the researchers conclude.