Ultrasound-guided Serratus Anterior Plane Block, Along with Improved Parasternal Block, is Superior to Serratus Anterior Plane Block Alone in Relieving Pain for Rhinoplasty with Autologous Costal Cartilage

Chen, Chunmei; Xiang, Guihua; Liu, Quanle; Chen, Keyu; Wang, Huan; Jin, Jing; Huang, Yan; Deng, Xiaoming; Yang, Dong; Yan, Fuxia

doi:10.1007/s00266-022-03230-w

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…35 When autologous costal cartilage harvesting is anticipated, vari-ous preharvest local nerve blocks (intercostal, parasternal) have been correlated with lower pain scores and decreased need for opioid rescue analgesia in the first 12 to 24 hours after surgery. 36,37 For patients undergoing autologous costal cartilage grafting, a muscle-sparing technique has been proposed whereby the deep muscular fascia and muscle fibers are separated from the rib using blunt dissection rather than electrocautery. 38 The mean postoperative pain score was consistently lower for the muscle-sparing group compared to the control group, with this difference remaining significant up for to 15 days with resting pain and up to 45 days for movement pain.…”

Section: Additional Strategies To Reduce Postoperative Pain and Opioi...mentioning

confidence: 99%

Opioid-Sparing Pain Control after Rhinoplasty: Updated Review of the Literature

Liu

Lee

2023

Facial Plast Surg

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Rhinoplasty is one of the most performed elective surgeries, and given the opioid crisis, increasing research and studies are focused on successful pain control with multimodality opioid-sparing techniques, such as acetaminophen, non-steroidal anti-inflammatory drugs, and gabapentin. Although limiting overuse of opioids is critical, this cannot be at the expense of inadequate pain control, particularly as insufficient pain control can be correlated with patient dissatisfaction and the postoperative experience in elective surgery. There is likely significant opioid overprescription, as patients often report taking less than 50% of their prescribed opioids. Furthermore, excess opioids provide opportunities for misuse and opioid diversion if not disposed of properly. To optimize postoperative pain control and minimize opioid requirements, interventions must occur at the preoperative, intraoperative, and postoperative timepoints. Preoperative counseling is imperative to set expectations for pain and to screen for predisposing factors for opioid misuse. Use of local nerve blocks and long-acting analgesia in conjunction with modified surgical techniques can lead to prolonged pain control. Postoperatively, pain should be managed with a multimodal approach, incorporating acetaminophen, NSAIDs, and potentially gabapentin with opioids reserved for rescue analgesia. Rhinoplasty represents a category of short-stay, low/medium pain, and elective procedures highly susceptible to overprescription and consequently, are readily amenable to opioid minimization through standardized perioperative interventions. Recent literature on regimens and interventions to help limit opioids after rhinoplasty are reviewed and discussed here.

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Section: Additional Strategies To Reduce Postoperative Pain and Opioi...mentioning

confidence: 99%