JAMA FPS JAMA Facial Plastic Surgery · 2018

Opioid Use by Patients After Rhinoplasty

Patel S, Sturm A, Bobian M, Svider PF, Zuliani G, Kridel R.

PubMed 29121158 Publisher (DOI)Free full text (PMC)

What this paper says

Of 20 to 30 opioid tablets prescribed after rhinoplasty, 62 patients used a mean of 8.7, about 40 percent of what they were given, and only 3 patients (5 percent) needed a refill.

Overview

Unused prescription opioids contribute to misuse and diversion. This case series measured how many tablets rhinoplasty patients actually take, across three fellowship-trained facial plastic surgeons in two states, and compared use across patient and procedure characteristics.

Sections of note

62 patients operated by 3 surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016.
Mean age 38.7 years, SEM 16.4; 50 female patients (81%).
Tablets were hydrocodone bitartrate 5 mg with acetaminophen 325 mg; use was self-reported.
Initial prescriptions were 20 to 30 tablets; mean use was 8.7 tablets, SEM 0.9, about 40 percent of what was prescribed.
46 patients (74%) used 15 or fewer tablets; 3 patients (5%) required a refill.
Sex, age, concurrent septoplasty or turbinate reduction, use of osteotomy, and prior rhinoplasty were not associated with the number of tablets used.
Adverse effects: drowsiness 22 patients (35%), nausea 7 (11%), light-headedness 3 (5%), constipation 3 (5%).

What it means for a patient

Most people used well under half of the opioid tablets they were sent home with.
Whether the operation included bone cuts, turbinate work, or was a revision did not change how much was used.
More than a third experienced drowsiness from the medication.
Limits: 62 patients, 3 surgeons, self-reported tablet counts, and no measurement of whether pain was adequately controlled at lower doses.

Why this paper matters

Overprescribing after outpatient surgery is a documented source of leftover opioids in circulation, and this quantifies the gap for rhinoplasty specifically. The finding supports prescribing closer to 15 tablets than 30. It does not test a reduced prescription prospectively.

Terms

Opioid: A class of strong pain medication that carries dependence risk.
Hydrocodone-acetaminophen: A common combination tablet of an opioid and paracetamol.
Diversion: Prescription medication passing to someone it was not prescribed for.
Osteotomy: A controlled surgical cut through bone.
Case series: A report on a group of patients with no comparison group.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Given the increase in opioid addiction and overdose in the United States, reasoned opioid use after outpatient surgery may affect prescription medication abuse.

Objectives: To examine patient use of opioids after rhinoplasty and establish an optimal postrhinoplasty pain management regimen.

Design, Setting, And Participants: In this case series, opioid use was evaluated in 62 patients who underwent rhinoplasty performed by 3 fellowship-trained facial plastic surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016.

Main Outcomes And Measures: Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed.

Results: The mean (SEM) age of the patients was 38.7 (16.4) years and included 50 female patients (81%). Of the initially prescribed 20 to 30 hydrocodone-acetaminophen combination tablets, the 62 patients included in this study used a mean (SEM) of 8.7 (0.9) tablets, only 40% of those prescribed after rhinoplasty. In addition, 46 patients (74%) consumed 15 or fewer tablets, whereas only 3 patients (5%) required refills of pain medication. Sex, age, concurrent septoplasty or turbinate reduction, use of osteotomy, and history of a rhinoplasty were not associated with the number of tablets used. The most common adverse effects included drowsiness in 22 patients (35%), nausea in 7 (11%), light-headedness in 3 (5%), and constipation in 3 (5%).

Conclusions And Relevance: To mitigate the misuse or diversion of physician-prescribed opioid medications, surgeons must be steadfast in prescribing an appropriate amount of pain medication after surgery. A multifaceted pain control program is proposed to manage postoperative pain and ascertain the balance between controlling pain and avoiding overprescribing narcotics.

Level Of Evidence: NA.

Abstract as indexed by PubMed; the article is open access (PubMed Central).