Objectives: Despite increased concern with the opioid epidemic, literature remains scant regarding narcotic prescription and use following tonsillectomy.
Study design: Retrospective cohort study with telephone interview.
Subject and methods: A chart review from January to August 2018 evaluated the difference between prescribed amounts of narcotic and patient-reported usage following tonsillectomy (Current Procedural Terminology codes 42821 and 42826). Patients were excluded if they used opioids for chronic pain, had a history of chronic opioid use or substance abuse, or underwent tonsillectomy to exclude malignancy. A telephone interview assessed opioid and nonopioid usage and pain control postoperatively, including amount and form of narcotics remaining.
Results: Sixty-four patients were enrolled at a mean 4.47 months after tonsillectomy. The mean ± SD prescribed morphine milligram equivalent (MME) was 456.1 ± 281.7, with only 302.8 ± 206.2 consumed. The mean MME prescribed per day was 74.1 ± 44.8, and average days of narcotic usage postoperatively was 9.6 ± 4.6, correlating with a mean MME per day of 49.2 ± 34.3 if the maximum prescribed dose per day was consumed. Fifty-four (84.4%) patients reported pain as well controlled. Forty-three (67.2%) patients reported residual narcotic medication, with 228.1 ± 208.5 MMEs remaining per patient. Narcotic solutions were more completely consumed than tablet forms, with 23.1% and 44.0% remaining, respectively. Patients cited uncertainty about safe disposal and safeguarding for future use as reasons for keeping residual narcotic.
Conclusions: Patient-reported narcotic use is significantly lower than the amount prescribed after tonsillectomy for benign disease. Providers can use these data to adjust narcotic-prescribing patterns while maintaining appropriate pain management for patients undergoing tonsillectomy.
Keywords: morphine milligram equivalent; narcotic; opioid; postoperative pain; tonsillectomy.