Prospective Randomized Trial Comparing Opioids versus Nonsteroidal Antiinflammatory Drugs for Postoperative Analgesia in Outpatient Rhinoplasty

Overview

The trial addresses overprescription of opioids after surgery. Seventy patients were randomized to receive either 5 mg hydrocodone with 325 mg acetaminophen, the opioid control group, or 400 mg ibuprofen, the anti inflammatory experimental group. Pain was assessed on postoperative days 1, 2 and 7 using numeric pain ratings, along with how often and how much medication was used.

Sections of note

• Prospective randomized trial, 70 patients; the journal grades it therapeutic level of evidence II.
• Groups did not differ significantly in gender, P equals 0.81, or age, P equals 0.61.
• On day 0 the anti inflammatory group scored 2.54 plus or minus 1.57 against 3.14 plus or minus 1.75 for opioids, meeting the noninferiority test, P equals 0.003.
• On day 1 the anti inflammatory group had a lower mean pain score, 1.84 plus or minus 1.29 against 2.46 plus or minus 1.90, P equals 0.01.
• By day 7 the difference lost statistical significance, 3.29 against 3.14, P equals 0.17.
• Mean day of stopping medication did not differ, 4.73 against 4.28, P equals 0.26.
• Seventy six percent of patients prescribed opioids took fewer than eight tablets.
• Five patients escalated from the anti inflammatory drug to opioids, and no adverse effects related to it were reported.

What it means for a patient

• A common over the counter anti inflammatory controlled pain at least as well as an opioid in the first days after rhinoplasty.
• Five of the anti inflammatory patients still needed an opioid, so it did not work for everyone.
• Anti inflammatory drugs are often avoided after nasal surgery over bleeding concerns; no adverse effects were reported here, though the trial was not powered to detect rare bleeding.
• Seventy patients at one centre is small, and pain was self reported.

Why this paper matters

Rhinoplasty is a common outpatient operation and a routine source of opioid prescriptions. This is a randomized trial rather than a survey, which makes its comparison stronger than most in this area. Bleeding risk with routine anti inflammatory use remains the unresolved question.

Terms

• NSAID: a non steroidal anti inflammatory drug such as ibuprofen.
• Opioid: a strong prescription painkiller carrying dependence risk.
• Hydrocodone: an opioid, here combined with acetaminophen.
• Noninferior: shown to be not meaningfully worse than the comparison treatment.
• Randomized trial: a study assigning treatment by chance to reduce bias.