RESUMO
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.
Assuntos
Analgésicos Opioides/uso terapêutico , Dermatologia , Prescrições de Medicamentos/normas , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Masculino , Guias de Prática Clínica como AssuntoRESUMO
The ideal biologic warfare agent is lethal, easy, and inexpensive to produce in large quantities, stable in aerosol for/with the ability to be dispersed over wide areas, has no effective treatment or vaccine, and is communicable from person to person. With the exception of the last characteristic, the biologic toxins (ricin, staphylococcal enterotoxin B, T-2 mycotoxin, and botulinum) possess all the properties mentioned. This article will discuss the first three biologic toxins, with an emphasis on particular points of interest to the dermatologist. Botulinum toxin will be covered in another article.