Developing, Implementing, and Evaluating an Opioid-Sparing Thyroid/Parathyroid Anesthesia Protocol: A Quality Improvement Initiative

The recent scrutiny around opioid use and abuse in the United States has been alarming. As anesthesia providers, we are tasked with managing both acute and chronic pain in a variety of settings. A balanced, opioid-sparing technique has been demonstrated to be effective for a variety of different surgical procedures in the literature. In this paper, we discuss opioid-sparing anesthetics for patients undergoing thyroid and parathyroid surgery. This project was completed by doing a retrospective chart review before and after the implementation of an opioid-sparing protocol. The protocol was developed from an evidence-based literature review on the subject. Primary outcomes were evaluating the protocol’s effect on postoperative nausea and vomiting (PONV), overall pain scores at multiple stages throughout the stay in PACU, respiratory depression, and total opioid dose in morphine-milligram equivalents (MME). Secondary outcomes were time spent in PACU and protocol compliance. A total of 30 patients meeting inclusion criteria received the protocol from November 2021 through February 2022. When compared to a similar pre-intervention cohort, those that received the protocol had significantly less PONV (10% in protocol group vs. 90% in pre-protocol group). Other outcomes that were analyzed had no statistical significance. Since thyroid/parathyroid surgeries are not associated with significant perioperative pain, an opioid-sparing anesthesia for these surgeries may decrease negative outcomes associated with opioid administration.