Postoperative pain and analgesic requirements after septoplasty and rhinoplasty

• Published in: The Laryngoscope 2019-09, Vol.129 (9), p.2020-2025
• Main Authors: Sclafani, Anthony P., Kim, Matthew, Kjaer, Klaus, Kacker, Ashutosh, Tabaee, Abtin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analgesia; Analgesics, Opioid - therapeutic use; Drug Prescriptions - statistics & numerical data; Female; Humans; Male; Middle Aged; Narcotics; Nasal Septum - surgery; opioids; Pain; Pain Management - methods; Pain Management - statistics & numerical data; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Postoperative period; Prospective Studies; Rhinoplasty; Rhinoplasty - adverse effects; septoplasty; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.27913

Objectives/Hypothesis To assess and define the level of pain after rhinoplasty and septoplasty and to better define the strength and quantity of postoperative opioids needed. Study Design Prospective outcomes research. Methods Two groups of patients were enrolled. One group underwent septoplasty with/without turbinate reduction and the other group underwent functional and/or cosmetic rhinoplasty (with/without septoplasty). Patients completed a 15‐day log (daily, beginning on the day of surgery) to record the analgesics used and the daily maximal level of pain using a visual analog scale. Level of pain, number of days of moderate or severe pain, total number of opioid pills used, and total morphine milligram equivalents (MMEs) of opioid used were assessed. Results Pain after septoplasty and rhinoplasty was generally mild. Average pain was moderate through postoperative day (POD) 2 after rhinoplasty and only on POD 0 after septoplasty. There was no statistically significant difference between the two groups in terms of number of opioid tablets consumed or total MMEs used. Patients undergoing rhinoplasty consumed more acetaminophen than septoplasty‐only patients (7471 ± 1009 vs. 2781 ± 585, P = .0112). Ninety percent of patients would have received adequate analgesia with as few as 11 opioid tablets. All patients had excess opioid at the end of the study period. Conclusions Both septoplasty and rhinoplasty are associated with mostly mild pain, and postoperative opioid requirements are quite low. Surgeons can reliably reduce opioid prescription after septoplasty and rhinoplasty to as few as 11 tablets. Reducing opioid prescribing will not adversely affect the patient but will reduce the availability of opioids for misuse or diversion. Level of Evidence 2c Laryngoscope, 129:2020–2025, 2019