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

Overview

Rhinoplasty is one of the most performed elective operations, and the opioid crisis has driven research into controlling pain without them. The review covers acetaminophen, nonsteroidal anti-inflammatory drugs and gabapentin, and argues that limiting opioids must not come at the cost of undertreated pain, since inadequate pain control correlates with dissatisfaction after elective surgery.

Sections of note

• Article type: narrative review of the literature. No new patient data reported.
• Stated evidence of overprescription: patients often report taking less than 50 percent of the opioids prescribed.
• Excess opioids create opportunities for misuse and diversion if not disposed of properly.
• Preoperative: counseling to set pain expectations and screening for risk factors for opioid misuse.
• Intraoperative: local nerve blocks and long acting analgesia combined with modified surgical technique for prolonged pain control.
• Postoperative: a multimodal regimen of acetaminophen, nonsteroidal drugs and possibly gabapentin, with opioids kept for rescue only.
• Rhinoplasty is characterized as a short stay, low to medium pain elective procedure, and therefore well suited to standardized opioid minimization.

What it means for a patient

• Pain after rhinoplasty is generally moderate and can usually be managed with over the counter class drugs plus a small opioid supply held in reserve.
• Filling a large opioid prescription you do not use creates a disposal problem and a risk to others in the household.
• The abstract reports no pain scores or comparative trial results, so the size of the benefit from any specific regimen is not stated.
• Undertreated pain is flagged as its own risk, linked to worse satisfaction with the whole experience.

Why this paper matters

Elective facial surgery has been a large source of leftover opioids in circulation, and rhinoplasty is a high volume example. Standardized non-opioid protocols are the practical response. Which combination of drugs works best, and at what doses, is not settled here.

Terms

• Opioid-sparing: a pain plan designed to use as little opioid medication as possible.
• Multimodal analgesia: combining drugs that work by different mechanisms.
• NSAID: a nonsteroidal anti-inflammatory drug such as ibuprofen.
• Nerve block: local anesthetic injected around a nerve to numb the area it supplies.
• Rescue analgesia: medication taken only when other pain control proves insufficient.
• Opioid diversion: prescribed opioids ending up used by someone other than the patient.