Pain and Pain Control With Opioid and Nonopioid Medications After Otologic Surgery

Objective: To prospectively analyze pain and pain medication use following otologic surgery. Study Design: Prospective cohort study with patient reported pain logs and medication use logs. Setting: Tertiary academic hospital. Patients: Sixty adults who underwent outpatient otologic surgeries. Interventions: Surveys detailing postoperative pain levels, nonopioid analgesic (NOA) use, and opioid analgesic use. Main Outcome Measures: Self-reported pain scores, use of NOA, and use of opioid medications normalized as milligrams morphine equivalents (MME). Results: Thirty-two patients had surgery via a transcanal (TC) approach, and 28 patients had surgery via a postauricular (PA) approach. TC surgery had significantly lower reported pain scores than PA surgery on both postoperative day (POD) 1 (median pain score 2.2, IQR 0-5 vs. median pain score 4.8, IQR 3.4-6.3, respectively; p = 0.0013) and at POD5 (median pain score 0, IQR 0-0 vs. median pain score 2.0, IQR 0-3, respectively; p = 0.0002). Patients also used significantly fewer opioid medications with TC approach than patients who underwent PA approach at POD1 (median total MME 0, IQR 0-5 vs. median total MME 5.0, IQR 0-15, respectively; p = 0.03) and at POD5 (median total MME 0, IQR 0-0 vs. median total MME 0, IQR 0-5, respectively; p = 0.0012). Conclusions: Surgery with a postauricular approach is associated with higher pain and opioid use following otologic surgery. Patient- and approach-specific opioid prescribing is feasible following otologic surgery.