Are nonsteroidal anti‐inflammatory drugs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty? A randomized, controlled study

Abstract

Background Endoscopic sinus surgery (ESS) and septoplasty are commonly performed procedures without standardized postoperative pain regimens. There is reluctance to prescribe opioids for postoperative pain given their potential for abuse. Nonsteroidal anti‐inflammatory drugs (NSAIDs) have been demonstrated to reduce or even obviate the need for opioid pain medications after otolaryngologic surgeries, but prospective validation is lacking. Methods A randomized, controlled study comparing the efficacy of diclofenac sodium to hydrocodone/acetaminophen (APAP) after ESS with or without septoplasty was performed. Participants were given a 100‐mm visual analog pain scale (VAS) at postoperative days (PODs) 1, 2, 3, and 5 after ESS. Two‐sample t tests were used to compare pain scores between groups. Results One hundred patients enrolled, and 74 patients provided pain scores to the survey. Pain was greatest for both groups on POD 1. Treatment with diclofenac sodium vs hydrocodone/APAP did not statistically impact pain scores at PODs 1, 2, 3, or 5. No cases of epistaxis requiring an emergency room visit or return to the operating room were noted during the study period. Conclusion Diclofenac sodium may be non‐inferior to hydrocodone/APAP in treating pain after ESS with or without septoplasty in opioid naive patients without pre‐existing pain conditions. Further studies with larger samples are warranted to investigate the potential superiority of diclofenac to hydrocodone/APAP in certain patients after ESS and septoplasty.

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

“…Overall, nine out of 15 RCTs demonstrated a low risk of bias 25,28–30,32,33,35,37,38 . Four trials demonstrated a high risk of bias due to missing outcome data 24,27,34,36 . A high risk of bias in measurement of outcome was detected in four trials 24,26,31,36 .…”

“…Fifteen RCTs enrolled a total of 1210 patients (median 75 patients, range 28 to 150). Six studies were carried out in Turkey 25,29–31,35,37 and five were conducted in the United States 24,27,33,34,36 . The rest of the studies were conducted in China, 26,38 Italy, 32 or Egypt 28 .…”

“…Among the RCTs, NSAIDs were given preoperatively in nine studies, 25,26,28–32,35,37 and postoperatively in five studies 22,24,33,34,36 . In one study, 38 NSAIDs were given both before and after surgery.…”

“…Six trials included in the meta‐analysis reported pain scores after ESS 26,27,30,31,33,36 . Overall, the effect size between the NSAIDs and non‐NSAIDs groups was small and did not meet the criteria for statistical significance (standardized mean difference [SMD] 0.44 units, 95% CI –1.05 to 0.18, I 2 = 91%, Figure 2).…”

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

“…4 Recently, research in head and neck cancer, rhinology, and sinus surgery suggest that alternative pain management therapies like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or steroids adequately treat pain and maintain patient satisfaction postoperatively. [20][21][22][23][24][25][26][27][28][29][30] However, less evidence validates these therapies in otology.…”