Key Action Statements

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Opioid Prescribing for Analgesia After Common Otolaryngology Operations

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Apr 5, 2021

Page Last Updated: May 5, 2026

Recommendation Grading System

Strength of Action Terms in Guideline Statements and Implied Levels of Obligation
Strength	Definition	Implied Obligation
Strong Recommendation (S)	A strong recommendation means that the benefits of the recommended approach clearly exceed the harms (or that the harms clearly exceed the benefits, in the case of a strong negative recommendation) and that the quality of the supporting evidence is excellent (grade A or B). In some clearly identified circumstances, strong recommendations may be made on the basis of lesser evidence, when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.	Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Recommendation (R)	A recommendation means that the benefits exceed the harms (or that the harms exceed the benefits, in the case of a negative recommendation) but that the quality of evidence is not as strong (grade B or C). In some clearly identified circumstances, recommendations may be based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms.	Clinicians should also generally follow a recommendation but should remain alert to new information and sensitive to patient preferences.
Option (O)	An option means that either the quality of evidence is suspect (grade D) or that well-done studies (grade A, B, or C) show little clear advantage to one approach versus another.	Clinicians should be flexible in their decision making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role.

Aggregate Grades of Evidence by Question Type
Grade	Treatment	Diagnosis	Prognosis
A	Systematic review^a of randomized trials	Systematic review^a of cross-sectional studies with consistently applied reference standard and blinding	Systematic review^a of inception cohort studies^b
B	Randomized trials, or observational studies with dramatic effects or highly consistent evidence	Cross-sectional studies with consistently applied reference standard and blinding	Inception cohort studies^b
C	Non-randomized or historically controlled studies, including case-control and observational studies	Non-consecutive studies, case-control studies, or studies with poor, non-independent, or inconsistently applied reference standards	Cohort study, control arm of a randomized trial, case series, or case-control studies; poor quality prognostic cohort study
D	Case reports, mechanism-based reasoning, or reasoning from first principles
X	Exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm

^a A systematic review may be downgraded to level B because of study limitations, heterogeneity, or imprecision
^b A group of individuals identified for subsequent study at an early, uniform point in the course of the specified health condition, or before the condition develops.

Document Overview

Document Title: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Document Publication Date: Apr 5, 2021

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599821996297

Source Citation: Anne SA, Mims JW, Tunkel DE, et al. Clinical practice guideline: opioid prescribing for analgesia after common otolaryngology operations. Otolaryngol Head Neck Surg. 2021;164(2_suppl):S1-S42.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of this specialty-specific CPG is to provide clinicians who treat patients with otolaryngologic disorders with evidence-based recommendations on perioperative opioid-based pain management for common otolaryngologic surgical procedures. This guideline also identifies quality improvement opportunities, including patient assessment, side effect and complication prevention, and reduction in unnecessary variation in practice.

Scope: Assessment and Screening, Management

Diseases/Conditions (MeSH)

D010036 -

Keywords: Clinical Practice Guideline, Pain Management, Prescribing of Opioids, analgesia, otolaryngology surgery

Target Patient Population: any individual who requires treatment for anticipated or reported pain within 30 days after common otolaryngologic procedures

Target Provider Population: otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures

Inclusion Criteria: Male, Female, Adolescent, Adult

Health Care Settings: Ambulatory, Emergency Care, Hospital

Intended Users: Addiction Treatment Specialist, Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 230

Literature Search Start Date: Wednesday, December 31, 2008

Literature Search End Date: Friday, October 18, 2019

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Key Action Statements

1. Expected Pain

2. Modifying Factors

3A. Risk Factors for Opioid Use Disorder

3B. Patients at Risk for OUD

4. Shared Decision Making

5. Multimodal Therapy

6. Nonopioid Analgesia

7. Opioid Prescribing

8A. Patient Feedback

8B. Stopping Pain Medications

9. Storage and Disposal of Opioids

10. Assessment of Pain Control with Opioids

Recommendation Grading System

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology