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Kinley Beck, Petar Yanev, Tyson Jergensen, Joshua Iltis, Raul Membreno, Kendall Wannamaker, patricia rosales, jeong-hyeon sohn, Roberto Diaz-Rohena, Michael Singer; Narcotic Prescribing Patterns and Pain Management by Vitreoretinal Surgeons. Invest. Ophthalmol. Vis. Sci. 2018;59(9):860. doi: https://doi.org/.
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Opioid overdose is responsible for over 90 American deaths each day. The 2015 National Survey on Drug Use and Health in the United States estimated that, among the 92 million adults prescribed opioid drugs in the prior year, 13% reported prescription opioid misuse. The Center for Disease Control estimates that the total economic burden of opioid misuse is $78.5 billion annually when accounting for treatment costs, lost productivity, addiction programs, and criminal prosecutions. The purpose of our survey was to investigate the opioid prescribing patterns and pain management strategies by vitreoretinal surgeons.
A 13-question multiple-choice survey was created using surveymonkey.com and distributed by email to members of the American Society of Retina Specialists (ASRS).
A total of 194 retinal specialists participated in the survey. 80% are private practice retinal specialists. 83.7% reported that they do not routinely prescribe narcotics after 25-gauge vitrectomies vs. 10% that do. 43% routinely prescribe narcotics after scleral buckle surgeries vs. 53% that do not. 60.5% of retinal surgeons report primarily using retrobulbar blocks for intra-operative anesthesia during vitrectomies; 18.5% mainly general anesthesia; 18.5% mainly peribulbar blocks; and 2.5% sub-tenon’s blocks. For scleral buckle surgery, 44% mainly use general anesthesia, 40.8% retrobulbar blocks, 9.7% peribulbar blocks, and 3.5% do not perform scleral buckles. The frequency of patients complaining of significant pain the day after small gauge vitrectomy surgery was reported to occur once a month or more often by 12.4% of survey responders vs. 36.7% after scleral buckle surgery. 4.1% reported nausea/vomiting at that same frequency after vitrectomy vs. 11.8% after scleral buckle surgery. Significant pain occurring once a month or more often was found to be statistically significant when comparing vitrectomy and scleral buckle surgery using the two-sample two-sided proportion test (p<0.01, see chart 1).
The majority of vitreoretinal surgeons does not routinely prescribe narcotics and are not contributing to the opioid epidemic. Significant pain was reported to occur more frequently with scleral buckle than vitrectomy surgery. However, the frequency of pain is still relatively low in absolute terms and narcotics should be reserved only for those few patients with significant pain that persists after acetaminophen.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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