Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

Abstract

Objectives/Hypothesis Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non‐opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. Study Design Evidence‐based systematic review. Methods PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. Results Thirty‐seven studies met inclusion criteria for this evidence‐based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti‐inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. Conclusions Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α‐agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost‐effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large‐scale, multi‐institutional, controlled studies are needed to provide definitive recommendations. Level of Evidence NA Laryngoscope, 129:E200–E212, 2019

The effectiveness of endoscopic sphenopalatine ganglion block in management of postoperative pain after septal surgery

“…An evidence‐based review on non‐opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty found that NSAIDS, gabapentin, α‐agonists, and local anesthetics were as effective as opioid alternatives in terms of perioperative analgesia. In that study, the use of local anesthetic was found to be a safe, rapid‐onset action, and a cost‐effective option in reducing postoperative pain scores and rescue analgesic requirements …”

“…Despite considerable improvements in analgesia and surgical techniques, there is no consensus for pain control and avoidance of overprescription after nasal surgery. Numerous pain medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDS), gabapentin with or without intravenous dexamethasone, opioids, and multimodal or balanced analgesic protocols that include non‐opioid analgesic drugs such as paracetamol, and various NSAIDS in combination with low doses of opioids were previously studied for postoperative pain management after nasal surgery . However, systemic use of these agents is associated with potential side effects .…”

“…Numerous pain medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDS), gabapentin with or without intravenous dexamethasone, opioids, and multimodal or balanced analgesic protocols that include non‐opioid analgesic drugs such as paracetamol, and various NSAIDS in combination with low doses of opioids were previously studied for postoperative pain management after nasal surgery . However, systemic use of these agents is associated with potential side effects . Local anesthetics (regional block or topical application via nasal packing) can be used as alternatives to high‐dose analgesics and to narcotics in an attempt to reduce analgesic‐associated side effects.…”

The relations between the level of Mu-opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: A prospective randomized controlled trial.

“…Low pain level of the patient will speed up recovery, provide a comfortable process and minimize the cost [12]. It is beneficial for the patient to apply a local anesthetic agent to the surgical area during the surgery, as it causes decreased postoperative pain scores and additional analgesic requirements [13]. In a recent study, the addition of a local anesthetic agent to the nasal packs after septal surgery has been shown to have positive effects in reducing postoperative pain within the first 12 hours [14].Steroids such as methylprednisolone are used due to anti-inflammatory and immunosuppressive effects [15].…”

The relations between the level of Mu-opioid receptor (μORs) and postoperative analgesic use in patients undergoing septoplasty: A prospective randomized controlled trial.

“…Low pain level of the patient will speed up recovery, provide a comfortable process and minimize the cost [11]. It is beneficial for the patient to apply a local anesthetic agent to the surgical area during the surgery, as it causes decreased postoperative pain scores and additional analgesic requirements [12]. In a recent study, the addition of a local anesthetic agent to the nasal packs after septal surgery has been shown to have positive effects in reducing postoperative pain within the first 12 hours [13].…”