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An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures - 11/02/20

Doi : 10.1016/j.jaad.2019.09.080 
Justin M. McLawhorn, MD a, , Matthew P. Stephany, MD a, William E. Bruhn, BS b, Lauren D. Crow, MD c, Brett M. Coldiron, MD d, George J. Hruza, MD e, Brian C. Leach, MD f, Seaver L. Soon, MD g, Daniel P. Friedmann, MD h, William G. Stebbins, MD i, Travis W. Blalock, MD j, Michael S. Graves, MD k, Elizabeth M. Billingsley, MD l, Thomas J. Knackstedt, MD m, Stanley J. Miller, MD n, Edward H. Yob, DO o, John G. Albertini, MD p, Nathalie Zeitouni, MD, CM q, Richard A. Krathen, MD r, Christopher K. Bichakjian, MD s, Nathaniel J. Jellinek, MD t, C. William Hanke, MD, MPH, FACP u, Faramarz H. Samie, MD, PhD v, Margaret W. Mann, MD w, John A. Carucci, MD, PhD x, Rohit Kakar, MD y, Drew K. Saylor, MD z, Scott W. Fosko, MD aa, Arisa E. Ortiz, MD bb, William B. Henghold, MD cc, Thomas A. Jennings, MD, PhD dd, DiAnne S. Davis, MD ee, Mary E. Maloney, MD ff, Natalie M. Curcio, MD, MPH gg, Ramona Behshad, MD hh, Whitney D. Tope, MD, MPhil ii, Holly McCoppin, MD jj, Jarad I. Levin, MD a, Lindsey Collins, MD a, Thomas Stasko, MD a
for the

Opioid-Prescribing in Dermatology Workgroup

  An acknowledgement of contributing panel members from the Opioid-Prescribing in Dermatology Workgroup is provided in the supplemental materials (available at DOI: txn52xptm6.1).

a Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 
b Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 
c Department of Dermatology, University of California San Francisco, San Francisco, California 
d Department of Dermatology, University of Cincinnati, Cincinnati, Ohio 
e Departments of Dermatology and Otolaryngology, St. Louis University/Laser and Dermatologic Surgery Center, St Louis, Missouri 
f Skin Surgery Center of Charleston, Charleston, South Carolina 
g The Skin Clinic MD, San Diego, California 
h Westlake Dermatology Clinical Research Center, Westlake Dermatology & Cosmetic Surgery, Austin, Tennessee 
i Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee 
j Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 
k Southwest Dermatology and Vein Clinic, Austin, Tennessee 
l Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania 
m Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio 
n Johns Hopkins Department of Dermatology, Towson, Maryland 
o Skin Cancer Center, Oklahoma Cancer Specialists and Research Institute, Tulsa, Oklahoma 
p The Skin Surgery Center, Winston Salem, North Carolina 
q Medical Dermatology Specialists, Phoenix, Arizona 
r Dermatology Associates of the Palm Beaches, PLLC, Palm Beach Gardens, Florida 
s Department of Dermatology, University of Michigan, Ann Arbor, Michigan 
t Department of Dermatology, Brown Medical School and University of Massachusetts Medical School, Dermatology Professionals, Inc, East Greenwich, Rhode Island 
u Ascension St. Vincent Hospital, Indianapolis, Indiana 
v Department of Dermatology, Columbia University, Irving Medical Center, New York, New York 
w Department of Dermatology, Case Western Reserve University, Innova Dermatology, Hendersonville, Tennessee 
x Ronald O. Perelman Department of Dermatology, New York, New York 
y Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California 
z Department of Dermatology, University of California San Francisco, San Francisco, California 
aa Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida 
bb Department of Dermatology, University of California San Diego, San Diego, California 
cc Henghold Skin Health and Surgery Group, Pensacola, Florida 
dd Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 
ee Gateway Aesthetic Institute and Laser Center, Salt Lake City, Utah 
ff Department of Dermatology, UMass Memorial Medical Center, Worcester, Massachusetts 
gg Curcio Dermatology, PC, Nashville, Tennessee 
hh Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri 
ii Academic Dermatology, PC, Edina, Minneapolis 
jj Lake Loveland Dermatology, PC, Loveland, Colorado 

Reprint requests: Justin M. McLawhorn, MD, OU Physicians Dermatology, 619 NE 13th St, Oklahoma City, OK 73104.OU Physicians Dermatology619 NE 13th StOklahoma CityOK73104

Abstract

Background

Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices.

Objective

To create opioid-prescribing consensus guidelines for common dermatologic procedures.

Methods

We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents.

Results

Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets.

Limitations

These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities.

Conclusions

Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Le texte complet de cet article est disponible en PDF.

Key words : opioid overuse, opioid guidelines, public health, Mohs micrographic surgery, dermatologic surgery, cosmetic dermatology, pain management, postoperative pain

Abbreviation used : MME


Plan


 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Approved (OUHSC IRB).


© 2019  American Academy of Dermatology, Inc. Tous droits réservés.
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Vol 82 - N° 3

P. 700-708 - mars 2020 Retour au numéro
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