TY - JOUR
T1 - Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty
T2 - An Evidence-Based Review
AU - Nguyen, Brandon K.
AU - Yuhan, Brian T.
AU - Folbe, Elana
AU - Eloy, Jean Anderson
AU - Zuliani, Giancarlo F.
AU - Hsueh, Wayne D.
AU - Paskhover, Boris
AU - Folbe, Adam J.
AU - Svider, Peter F.
N1 - Publisher Copyright:
© 2018 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Objectives/Hypothesis: Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. Study Design: Evidence-based systematic review. Methods: PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. Results: Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. Conclusions: Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations. Level of Evidence: NA. Laryngoscope, 129:E200–E212, 2019.
AB - Objectives/Hypothesis: Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. Study Design: Evidence-based systematic review. Methods: PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. Results: Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. Conclusions: Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations. Level of Evidence: NA. Laryngoscope, 129:E200–E212, 2019.
KW - Septoplasty
KW - nasal surgery
KW - pain control
KW - pain management
KW - perioperative analgesia
KW - rhinoplasty
KW - septorhinoplasty
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U2 - 10.1002/lary.27616
DO - 10.1002/lary.27616
M3 - Review article
C2 - 30585326
AN - SCOPUS:85059011924
SN - 0023-852X
VL - 129
SP - E200-E212
JO - Laryngoscope
JF - Laryngoscope
IS - 6
ER -