TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.
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October 2018Background
Nasal obstruction caused by a deviated nasal septum is a common problem dealt with in otolaryngology practice that successfully can be corrected with septoplasty in the majority of patients. To decrease the risks of postoperative complications, such as septal hematoma or postoperative bleeding, nasal packing traditionally has been used. However, nasal packing has been associated with increased postoperative pain, which may be due to the pressure exerted by the pack, surgical trauma to nasal mucosa, or the tension of sutures applied to the nasal septum.
Numerous pain medications, such as opioids, nonsteroidal anti-inflammatory drugs, acetaminophen, and regional blocks with local anesthetics, are prescribed to patients for acute postoperative pain in general. However, all these agents have potential side effects, such as nausea, vomiting, urinary retention, sedation, and respiratory depression.
Pregabalin is a lipophilic gamma-aminobutyric acid analogue with anticonvulsant, anxiolytic, and sleep-modulating properties. Pregabalin is used to reduce neuropathic pain, inflammatory pain, tissue irritation, neuralgia, and fibromyalgia. A number of studies have investigated the effects of pregabalin in the treatment of postoperative pain. This literature review specifically will look at the effects of pregabalin on postseptoplasty pain management. Of note, these studies focused on septoplasty postoperative management; therefore, these findings do not apply to other sinonasal procedures.
Best Practice
Pregabalin given one hour before septoplasty decreases postoperative pain and lowers the requirement for postoperative analgesics, with no significant increase in side effects. Although the optimal dose is unclear, doses of 75 mg to 300 mg have been used, and a single study showed that 150 mg leads to a greater improvement than 75 mg. The addition of IV dexamethasone to pregabalin may lead to a further decrease in postoperative pain and other analgesic utilization (Laryngoscope. 2018;128:1023–1024).