Opioids
In light of growing concerns regarding opioid abuse and concomitant government action on both the state and local level, a recent abstract by B. Kelly, MD, et.al. (http://bit.ly/1UV9V8e) is quite timely. As a result, it has received significant mention in the lay press. The authors did a meta-analysis comparing the use of NSAID’s (e.g., ibuprofen) versus opioids (e.g., codeine) following surgery. What this means is that they combed the literature to find any study or paper that has been written on this subject. Looking at 881 publications they found 4 articles. They then analyzed the data from those 4 articles for their study.
Their conclusions are based on a total of 186 patients having a variety of surgical procedures (out-patient breast surgery – 71, laparoscopic hernia repair 29, cosmetic facial surgery 18, Moh’s surgery and reconstruction 69). I think their effort is very commendable and their conclusions interesting, but not enough to convince me to change my current practice of post-operative pain management. If one considers the most common complication related to ibuprofen in the peri-operative period, bleeding or hematoma, the incidence is relatively small. In my opinion, the overall numbers in these 4 studies are too small to definitively answer the question. Yet for many of our plastic surgery procedures, the size of the flaps raised and spaces created make the sequelae of post-operative bleed potentially significant.
This abstract is quite timely and raises an important subject for investigation. What is needed, therefore, is a single, prospective, randomized, controlled, multi-center study enrolling many more patients than covered by this abstract. Until I see more convincing documentation, I will recommend to my patients that we initially manage their pain for the early post-operative period as needed understanding that the use of opioids is for acute pain and is a short-term therapy.