Opioid-Sparing Pain Control after Rhinoplasty: Updated Review of the Literature

Abstract

Rhinoplasty is one of the most performed elective surgeries, and given the opioid crisis, increasing research and studies are focused on successful pain control with multimodality opioid-sparing techniques, such as acetaminophen, non-steroidal anti-inflammatory drugs, and gabapentin. Although limiting overuse of opioids is critical, this cannot be at the expense of inadequate pain control, particularly as insufficient pain control can be correlated with patient dissatisfaction and the postoperative experience in elective surgery. There is likely significant opioid overprescription, as patients often report taking less than 50% of their prescribed opioids. Furthermore, excess opioids provide opportunities for misuse and opioid diversion if not disposed of properly. To optimize postoperative pain control and minimize opioid requirements, interventions must occur at the preoperative, intraoperative, and postoperative timepoints. Preoperative counseling is imperative to set expectations for pain and to screen for predisposing factors for opioid misuse. Use of local nerve blocks and long-acting analgesia in conjunction with modified surgical techniques can lead to prolonged pain control. Postoperatively, pain should be managed with a multimodal approach, incorporating acetaminophen, NSAIDs, and potentially gabapentin with opioids reserved for rescue analgesia. Rhinoplasty represents a category of short-stay, low/medium pain, and elective procedures highly susceptible to overprescription and consequently, are readily amenable to opioid minimization through standardized perioperative interventions. Recent literature on regimens and interventions to help limit opioids after rhinoplasty are reviewed and discussed here.

Comparative study between remifentanil (or fentanyl) and dexmedetomidine for the analgesia of rhinoplasty: A meta-analysis of randomized controlled trials

“…Rhinoplasty has become one of the most common surgeries in clinical work. [1–3] Surgical trauma and hemodynamic instability result in an increase in intraoperative bleeding, which negatively affects surgeon satisfaction, the quality of surgical field, intraoperative and postoperative complications, and surgical outcomes. [4–6] In order to improve surgeon satisfaction and surgical field quality, various drugs are developed to control blood pressure and decrease bleeding.…”