Opioid prescribing for acute postoperative pain after cutaneous surgery

Abstract

Background: Little information is available to predict which patients require opioid analgesia following cutaneous surgery. When opioids are indicated, information regarding the optimal opioid agent selection and dosage is lacking.

Objective: To make recommendations for opioid prescription after cutaneous surgery.

Methods: A PubMed literature search was conducted to review the available literature. Recommendations are presented on the basis of available evidence and the opinion of the authors.

Results: Most patients undergoing cutaneous surgery do not require opioid analgesia. For those who do, the duration of pain warranting opioid analgesia is generally less than 36 hours. Opioid refill requests warrant a follow-up visit to ascertain the cause of ongoing pain after excisional procedures.

Limitations: The recommendations are not based on prospective randomized trials.

Conclusions: The presented recommendations for opioid prescription practice are derived from available evidence, recommendations, and expert opinion.

Keywords: Mohs micrographic surgery; addiction; cutaneous surgery; dermatologic surgery; flap; narcotic; opioid; pain; public health.