An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures

Justin M. McLawhorn, Matthew P. Stephany, William E. Bruhn, Lauren D. Crow, Brett M. Coldiron, George J. Hruza, Brian C. Leach, Seaver L. Soon, Daniel P. Friedmann, William G. Stebbins, Travis W. Blalock, Michael S. Graves, Elizabeth M. Billingsley, Thomas J. Knackstedt, Stanley J. Miller, Edward H. Yob, John G. Albertini, Nathalie Zeitouni, Richard A. Krathen, Christopher K. BichakjianNathaniel J. Jellinek, C. William Hanke, Faramarz H. Samie, Margaret W. Mann, John A. Carucci, Rohit Kakar, Drew K. Saylor, Scott W. Fosko, Arisa E. Ortiz, William B. Henghold, Thomas A. Jennings, Di Anne S. Davis, Mary E. Maloney, Natalie M. Curcio, Ramona Behshad, Whitney D. Tope, Holly McCoppin, Jarad I. Levin, Lindsey Collins, Thomas Stasko

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)700-708
Number of pages9
JournalJournal of the American Academy of Dermatology
Volume82
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Mohs micrographic surgery
  • cosmetic dermatology
  • dermatologic surgery
  • opioid guidelines
  • opioid overuse
  • pain management
  • postoperative pain
  • public health

ASJC Scopus subject areas

  • Dermatology

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  • Cite this

    McLawhorn, J. M., Stephany, M. P., Bruhn, W. E., Crow, L. D., Coldiron, B. M., Hruza, G. J., Leach, B. C., Soon, S. L., Friedmann, D. P., Stebbins, W. G., Blalock, T. W., Graves, M. S., Billingsley, E. M., Knackstedt, T. J., Miller, S. J., Yob, E. H., Albertini, J. G., Zeitouni, N., Krathen, R. A., ... Stasko, T. (2020). An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures. Journal of the American Academy of Dermatology, 82(3), 700-708. https://doi.org/10.1016/j.jaad.2019.09.080