Postoperative Opioid Use in Rhinoplasty Procedures: A Standardized Regimen

Overview

The study set out to create a standardized approach to prescribing pain medication before and after rhinoplasty. Patients operated on by a single surgeon at a tertiary hospital were enrolled from August 2018 to November 2019 and asked to record pain scores and medication use for 14 days after surgery. Diaries were handed in at the second postoperative visit and pill counts were done to confirm the entries.

Sections of note

• Prospective study, single surgeon; 35 patients enrolled and 23 completed.
• Average age 39.07 plus or minus 15.01 years; 48 percent were female.
• Mean opioid consumption was 6.15 plus or minus 4.85 pills, range 0 to 18.
• Women took an average of 7.2 plus or minus 5.2 pills and men 4.5 plus or minus 3.96.
• Mean acetaminophen use was 7.48 plus or minus 8.52 tablets, range 0 to 36; mean ibuprofen use was 10.83 plus or minus 10.99 tablets, range 0 to 39.
• No postoperative nosebleeds were reported.
• Men had significantly higher pain scores than women on days 1 through 8; mean pain score for days 8 to 14 was under 1.
• Regression analysis found no association between the rhinoplasty technique used and opioid consumption.

What it means for a patient

• Pain after rhinoplasty was mild in this group, including when the nasal bones were cut.
• Most patients used more non opioid tablets than opioid pills over two weeks.
• Twenty three patients treated by one surgeon is a small basis for a prescribing standard.
• No bleeding occurred despite ibuprofen use, but the study was not designed to test bleeding risk.

Why this paper matters

Overprescription of opioids after minor surgery is a documented source of leftover pills and misuse. This study measures what rhinoplasty patients actually consume rather than what is typically prescribed. Whether seven pills is enough across other surgeons and patient groups has not been confirmed.

Terms

• Opioid: a strong prescription painkiller with dependence risk.
• Osteotomy: a controlled cut in the nasal bone to narrow or straighten the nose.
• Acetaminophen: a non opioid painkiller, also called paracetamol.
• Ibuprofen: a non steroidal anti inflammatory painkiller.
• Prospective study: one that collects data forward in time from enrollment.