Opioid-Sparing Protocol for Endocrine Surgery (OSPREY): A Prospective Study.

Abstract

Thyroid and parathyroid operations are amongst the most commonly performed surgeries in the world; however, there remains a paucity of prospective clinical trials evaluating the efficacy of opioid-sparing protocols following surgery. This prospective non-randomized study was performed between March and October 2021. Participants self-selected their cohort of either an opioid-sparing protocol of acetaminophen/ibuprofen or a treatment-as-usual protocol with opioids. Primary endpoints were Overall Benefit of Analgesia Scores (OBAS) and opioid use as reported in daily medication logs. Data were recorded over seven days. Multivariable regression, pooled variance t-tests, Mann-Whitney test, and chi-square tests were used to evaluate the results. A total of 87 participants were recruited; 48 participants opted for the opioid-sparing arm while 39 participants opted for the treatment as usual arm. Patients in the opioid-sparing arm used significantly less opioids (morphine equivalents 0.77 ± 1.71 vs. 3.34 ± 5.87, p=0.042) but had no significant difference in OBAS (p=0.37). Multivariable regression analysis demonstrated no significant difference in mean OBAS between treatment arms when controlling for age, sex, and type of surgery (p=0.88). There were no major adverse events in either group. An opioid-sparing treatment algorithm based on use of acetaminophen/ibuprofen may offer a safe and effective treatment algorithm compared to a primary opioid focused treatment pathway. Randomized adequately-powered studies are needed to confirm these findings.