American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery

Lee, Jivianne T.; Levine, Corinna G.; Overdevest, Jonathan B.; Higgins, Thomas S.; Manes, R. Peter; Myhill, Jeffrey; Soler, Zachary M.

doi:10.1002/alr.22847

Cited by 7 publications

(7 citation statements)

References 52 publications

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“…The reduction of nausea is not surprising given the opioid dose‐sparing effect of NSAIDs and likely subsequent reduction in postoperative nausea or vomiting 45 . The results of our study further support the recent expert statement from the American Rhinologic Society, which encourages the use of NSAIDs for pain analgesia after sinonasal surgery 46 …”

Section: Discussionsupporting

confidence: 82%

The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis

Lee

Grose

Brenna

et al. 2023

Int Forum Allergy Rhinol

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BackgroundNon‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery.MethodsMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting).ResultsOut of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22).ConclusionAmong patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.

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Section: Discussionsupporting

confidence: 82%

The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis

Lee

Grose

Brenna

et al. 2023

Int Forum Allergy Rhinol

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“…There has been concern with bleeding using postoperative nonsteroidal anti-inflammatory drugs, but risks do not appear to outweigh the benefits. [19][20][21] In our study, utilization of acetaminophen or ibuprofen was not different among patient groups, suggesting that patient utilization of opioids was not related to the absence of multi-modal strategies for pain control. Acetaminophen was provided as a prescription, utilized by nearly all patients (91%).…”

Section: Discussionmentioning

confidence: 45%

“…Postoperative multi‐modal strategies to reduce pain through nonopioid medications have been utilized, primarily with acetaminophen and ibuprofen. There has been concern with bleeding using postoperative nonsteroidal anti‐inflammatory drugs, but risks do not appear to outweigh the benefits 19–21 . In our study, utilization of acetaminophen or ibuprofen was not different among patient groups, suggesting that patient utilization of opioids was not related to the absence of multi‐modal strategies for pain control.…”

Section: Discussionmentioning

confidence: 53%

Pain and Opioid Consumption Following Endoscopic Sinus Surgery: A Prospective Cohort Study

et al. 2021

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Objectives/Hypothesis: Surgeons have a critical role in the current opioid epidemic, and there is a need to prospectively understand patterns of pain and opioid use among patients undergoing endoscopic sinus surgery (ESS).Study Design: Prospective observational cohort.Methods: This was a prospective, observational cohort study that included patients undergoing ESS from November 2019 to March 2020. Demographic data were collected at baseline, as was respondent information regarding preoperative anxiety, pain, and postoperative pain expectations. Opioid use was converted to milligram morphine equivalents (MME). All patients received 10 tablets of 5 mg oxycodone (75 MME). Patients quantified postoperative pain and opioid consumption via telephone follow-up every 48 hours. The primary outcome was total MME utilized.Results: There were 91 patients included in the final cohort. Mean opioid use was 35.2 AE 47.3 MME. There were 29 (32%) patients who did not use any opioids after surgery, and six (7%) patients who required opioid refills. Postoperative opioid use was associated with increased preoperative anxiety (r = 0.41, P < .001), preoperative pain (r = 0.28, P = .007), and expectations for postoperative pain (r = 0.36, P < .001). Increased postoperative pain was only associated with increased opioid use on postoperative days 0-2 (r = 0.33, P = .001) and 3-4 (r = 0.59, P < .001). On multivariate regression, former smoking (β = 23.4 MME, SE = 10.1, 95% confidence interval [CI]: 3.3-43.5, P = .023) and anxiety (β = 35.9, SE = 10.2, 95% CI: 15.6-56.3, P < .001) were associated with increased MME.Conclusions: The majority of patients have minimal opioid use after ESS, and pain appears to influence opioid use within the first 4 days after surgery. Additionally, patients with anxiety may benefit from alternative pain management strategies to mitigate opioid consumption.

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“…As highlighted in the recent expert practice statement from the American Rhinologic Society, no consensus could be reached regarding the efficacy of gabapentin in reducing postoperative opioid requirements following sinonasal surgery due to the limited literature on this topic. 19 The present study aims to fill this knowledge gap as we investigate whether postoperative administration of gabapentin can effectively decrease opioid consumption and control pain following ESS and/or septoplasty.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery

Yang

Suh

et al. 2022

The Laryngoscope

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Objective This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty. Methods Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone‐acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone‐acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non‐gabapentin groups. Results A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = −9.54, 95% C.I. = [−17.84, −1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = −1.59, 95% C.I. = [−5.03, 1.84], p = 0.36). Conclusion To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control. Level of Evidence 3 Laryngoscope, 133:1065–1072, 2023

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American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery

Cited by 7 publications

References 52 publications

The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis

The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis

Pain and Opioid Consumption Following Endoscopic Sinus Surgery: A Prospective Cohort Study

Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery

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