Postoperative Opioid Requirements Are Low for Rhinoplasty and Septoplasty Patients

What is the level of pain after rhinoplasty and septoplasty, and what strength and quantity of postoperative opioids are needed?

Commentary: “This prospective study evaluated pain thresholds in patients undergoing septoplasty or rhinoplasty to determine the amount of postoperative narcotic pain medication needed. The authors recommend that fewer opioid tablets be prescribed after these surgeries since 90% of patients achieved adequate analgesia with only 11 tablets.” —Cristina Cabrera-Muffly, MD

Bottom Line: 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.

Background: Patient comfort is an important consideration after surgery. Patients undergoing elective, ambulatory surgery should be provided with sufficient postoperative analgesia, which is usually an opioid. Opioid prescriptions and related deaths, however, are still significantly higher than they were in 1999, and little has been written about actual postoperative analgesic needs. 

Study design: Prospective outcomes research of two patient groups enrolled between December 2017 and October 2018 who underwent septoplasty with/without turbinate reduction (group 1 = 13) or underwent functional and/or cosmetic rhinoplasty (with/without septoplasty) (group 2 = 22).

Setting: New York–Presbyterian/Weill Cornell Medical Center, New York, N.Y.

Synopsis: All 13 septoplasties were performed endonasally; eleven were male and two were female, and the average age was 44.3 ± 15.7 years. Three patients were prescribed codeine/acetaminophen 30/300, whereas the remaining 10 received oxycodone/acetaminophen 5/325. The pain reported by septoplasty patients ranged from 0 to 78 on the visual analog scale (VAS). The mean number of opioid tablets used was 4.1 ± 4.4, with a mean total morphine milligram equivalents (MMEs) of 28.7 ± 34.1. These patients averaged 2,781 ± 585 milligrams of acetaminophen through postoperative day (POD) and reported a VAS score of at least 40 for 0.9 ± 1.1 days and at least 30 for 1.4 ± 1.1 days. Of the 22 rhinoplasty patients, 19 also had a septoplasty, including concurrent endoscopic sinus surgery in one. Twelve patients were female, and 10 were male, and their average age was 38.2 ± 14.8 years. Endonasal approaches were used in 13 cases, with an external approach used in nine cases. Two patients were prescribed codeine/acetaminophen 30/300, and 19 patients received oxycodone/acetaminophen 5/325; one patient refused any opioid prescription. The pain reported by rhinoplasty patients ranged from 0 to 88 on the VAS. The mean number of opioid tablets used was 4.4 ± 4.0, with a mean total MMEs of 28.7 ± 34.1. These patients averaged 7,471 ± 1,009 mg of acetaminophen through POD 14. Rhinoplasty patients reported a VAS score of at least 40 for 1.9 ± 1.9 days and at least 30 for 2.9 ± 2.7 days. All patients had opioids left at the end of the follow-up period. Statistical analysis showed no differences in total MMEs, number of opioid tablets consumed, or in overall VAS pain scores between groups, or between external versus endonasal approaches, nasal bone osteotomy treatments, weight, or BMI. There was a statistically significant difference between groups in the amount of postoperative acetaminophen used.

Citation: Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A. Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope. 2019;129:2020–2025.