An expert panel of members of the Opioid-Prescribing in Dermatology Workgroup has created a consensus guidance statement on the prescribing of opioids after various dermatologic procedural scenarios, published in the Journal of the American Academy of Dermatology. In the guidance statement, panelists find few scenarios in which postoperative opioids are needed. Instead, they recommend non-opioid analgesics in most opioid-naïve patients after common dermatologic procedures.
The Opioid-Prescribing in Dermatology Workgroup consisted of panelists with board certification in dermatology and an active DEA license. A discussion using a 4-step modified Delphi method was conducted to develop opioid-prescribing guidelines for dermatologic procedural cases frequently seen in the dermatology clinic. During the first round of questions, participants were tasked with discriminating between procedures requiring opioids for routine pain management and procedures that do not require opioid prescriptions.
A total of 40 panelists were also provided summarized responses and asked to select a discreet opioid pill (5-mg oxycodone oral equivalent) with a range considered appropriate for the described procedural scenarios. Based on these responses, consensus guidelines were developed for opioid-naïve patients scheduled to undergo 87 common routine dermatologic procedural scenarios.
Panelists agreed that non-opioid analgesics were appropriate as first-line pain management after a dermatologic procedure unless contraindicated. Acetaminophen 1 g every 8 hours and/or ibuprofen 400 mg every 4 hours were recommended to provide appropriate postoperative pain relief. In cases in which opioids are reasonably needed for adequate pain management, the panelists agreed that acetaminophen and/or nonsteroidal medications should be combined with opioid analgesics.
The panelists also agreed that 66 of the 87 procedural scenarios did not require a prescription of postoperative opioids. A maximum of 10 oxycodone 5-mg morphine equivalents for 20 of the 87 procedural scenarios and a maximum of 15 oxycodone 5-mg pills for 1 of the 87 scenarios was recommended.
Study limitations include the lack of input from patients and providers of other surgical subspecialties, as well as the possible selection bias introduced by the modified Delphi procedure.
“While not exhaustive,” the researchers wrote, “these guidelines provide additional resources to help address many uncertainties involved with the management of postoperative pain, and may be used as a starting point to formulate a pain management plan.”
McLawhorn JM, Stephany MP, Bruhn WE, et al; Opioid-Prescribing in Dermatology Workgroup. An Expert Panel Consensus on Opioid-Prescribing Guidelines for Dermatologic Procedures [published online November 1, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.080