FPSAM Facial Plastic Surgery and Aesthetic Medicine · 2026

Postoperative Pain Management in Rhinoplasty: A Double Blind Randomized Controlled Trial

Kandathil CK, Spataro EA, Saltychev M, Kalebjian R, Patel PN, Kim CH, Akkina SR, Kimura KS, Rossi-Meyer M, Longino ES, Truong H, Most SP.

PubMed 41777014 Publisher (DOI)

What this paper says

In 130 randomised rhinoplasty patients, paracetamol with ibuprofen controlled pain over the first five days as well as paracetamol with hydrocodone, and the opioid group itched more.

Overview

Evidence for non-opioid pain control after rhinoplasty has been thin. Adults having primary rhinoplasty at one tertiary centre were enrolled from August 2019 to October 2024 and randomised, with neither patient nor assessor knowing the assignment, to acetaminophen with hydrocodone or acetaminophen with ibuprofen. Pain was recorded on a visual analogue scale on days 0 to 5.

Sections of note

Double-blind randomised controlled trial, 130 patients completing, 65 per group.
Doses: acetaminophen 325 mg with either hydrocodone 5 mg or ibuprofen 200 mg, 1 to 2 tablets every 4 hours for five days.
Tramadol 50 mg was available in both groups for breakthrough pain.
Mean age 32 years; 77% women; 68% White; 52% had combined functional and aesthetic surgery.
No difference in mean pain scores across days 0 to 5, p = 0.156.
Of the side effects, only itchiness differed, and it was higher in the hydrocodone group, p = 0.001.

What it means for a patient

An over-the-counter combination gave the same pain relief as an opioid in this trial, which is a reason to ask for it.
Both groups had tramadol available for breakthrough pain, so neither arm was left without a stronger option.
Single centre, primary rhinoplasty only, and the trial was not designed to measure rare harms of either drug.

Why this paper matters

Rhinoplasty is a common source of a young adult's first opioid prescription. A blinded randomised trial showing no pain advantage removes the main argument for routine opioids after this operation. Whether the result holds for revision surgery or rib grafting was not tested.

Terms

Visual analogue scale (VAS): a 0 to 10 line on which patients mark their pain.
Double-blind: neither the patient nor the assessor knows which treatment was given.
Breakthrough pain: pain that gets past the scheduled medication.
Hydrocodone: an opioid painkiller.
Primary rhinoplasty: a first nose operation, not a revision.

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

From the abstract

“There is inadequate evidence for the utilization of nonnarcotic pain medications for postoperative pain management following rhinoplasty. Objective: To compare the effectiveness of opioid and non-opioid medications for postoperative pain control in rhinoplasty as measured by a visual analog scale (VAS) on…”

Excerpt; the full abstract is on PubMed.