FPSAM Facial Plastic Surgery and Aesthetic Medicine · 2026

Effect of an Enhanced Recovery after Surgery Protocol in Postoperative Pain and Opioid Consumption after Rhinoplasty

Brownlee B, Johnson A, Park S, Oyer S.

PubMed 42068123 Publisher (DOI)

What this paper says

In 51 open septorhinoplasty patients, a standardised non-opioid-first recovery pathway lowered mean first-week pain scores from 5.9 to 3.8, and opioid use did not rise.

Overview

Enhanced recovery after surgery pathways replace routine opioids with a fixed combination of other drugs. They are established in other fields but had not been studied in rhinoplasty. The authors compared patients operated before and after their unit introduced such a pathway, using patient-reported pain scores and opioid consumption over the first week.

Sections of note

Retrospective cohort study of open septorhinoplasty, before and after the pathway was introduced.
51 patients: 24 in the traditional cohort, 27 in the pathway cohort.
Traditional cohort received hydrocodone or oxycodone with non-standardised perioperative care.
Pathway cohort received tramadol, Celebrex, prednisone and acetaminophen on a standard schedule.
Mean pain score 3.8 with the pathway against 5.9 with traditional care, p = 0.0007.
Total morphine milligram equivalents 37.8 against 46.3, p = 0.51, so the opioid difference was not statistically significant.
Mean ages 35.4 and 37.6 years; the traditional cohort was 54% female, the pathway cohort 67%.

What it means for a patient

Better pain control in the first week came from the combination of non-opioid drugs, not from more opioid.
The opioid reduction seen here could be chance; only the pain score difference reached significance.
Retrospective, single centre, 51 patients, groups treated in different periods, so other changes in care could contribute.

Why this paper matters

Rhinoplasty is a common elective operation, and routine opioid prescriptions after it are a recognised source of first exposure. This is the first reported test of a structured recovery pathway in rhinoplasty. A prospective randomised comparison is still missing.

Terms

Enhanced recovery after surgery (ERAS): a fixed multi-drug, multi-step protocol used to speed recovery and cut opioid use.
Open septorhinoplasty: nose reshaping with septal work through an external incision on the columella.
Morphine milligram equivalent: a common unit for comparing doses of different opioids.
Retrospective cohort: a study of records from patients already treated.
Celebrex: an anti-inflammatory drug used in place of opioids.

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

From the abstract

“Enhanced recovery after surgery (ERAS) protocols reduce opioid exposure in many surgical fields, but their impact on rhinoplasty has not been studied. Objective: To compare postoperative pain control and opioid use during the first week after open septorhinoplasty among patients treated with a traditional…”

Excerpt; the full abstract is on PubMed.