There is evidence supporting the use of NSAIDs and gabapentin for the control of pain after endoscopic sinus surgery. Acetaminophen, α-agonists, and local anesthetics are also viable options for postoperative analgesia. Familiarity with these data is essential to facilitate the use of opioid alternatives. Further large-scale, multi-institutional, randomized trials are needed to provide conclusive recommendations for these perioperative analgesics.
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
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