Rhinoplasty/Septoplasty Patients Require Few Opioids for Postsurgical Pain

by Amy E. Hamaker •

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

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: Opioids are frequently prescribed after ambulatory surgery. Greater attention to opioid prescribing, state-mandated prescription drug monitoring programs, and greater access to opioid antagonists have begun to reverse these trends, but opioid prescriptions and related deaths are still significantly higher than they were in 1999. Little has been written about actual postoperative analgesic needs.

Study design: Prospective outcomes research of two groups of patients (13 who underwent septoplasty with or without inferior turbinate reduction surgery; 22 who underwent functional and/or cosmetic rhinoplasty, with or without septoplasty and turbinate reduction) between December 2017 and October 2018.

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

Synopsis: Patients completed a 15-day log, beginning on the day of surgery. Of the 13 septoplasties, patient-reported pain ranged from 0 to 78 (visual analog scale (VAS)). The mean number of opioid tablets used was 4.1 ± 4.4, with a mean total morphine milligram equivalents (MMEs) used of 28.7 ± 34.1. These patients averaged 2,781 ± 585 milligrams of acetaminophen through postoperative day (POD); they 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, patient-reported pain ranged from 0 to 88 (VAS). The mean number of opioid tablets used was 4.4 ± 4.0, with a mean total MMEs used of 28.7 ± 34.1. These patients averaged 7,471 ± 1,009 mg of acetaminophen through POD 14; they reported a VAS score at least 40 for 1.9 ± 1.9 days and at least 30 for 2.9 ± 2.7 days. All patients in both groups had excess opioids at the end of the follow-up period.

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