Brandon K Nguyen1,2, Brian T Yuhan1,2, Elana Folbe1, Jean Anderson Eloy3,4,5,6, Giancarlo F Zuliani1,7, Wayne D Hsueh3, Boris Paskhover3, Adam J Folbe2,8, Peter F Svider3. 1. Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan. 2. Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan. 3. Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey. 4. Department of Ophthalmology and Visual Science, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey. 5. Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey. 6. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey. 7. Zuliani Facial Aesthetics, Bloomfield Hills, Michigan. 8. Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. STUDY DESIGN: Evidence-based systematic review. METHODS: PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. RESULTS: Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. CONCLUSIONS: Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E200-E212, 2019.
OBJECTIVES/HYPOTHESIS: Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. STUDY DESIGN: Evidence-based systematic review. METHODS: PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. RESULTS: Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. CONCLUSIONS: Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E200-E212, 2019.
Authors: Austin T K Hoke; Madison Malfitano; Adam M Zanation; Charles S Ebert; Brent A Senior; Adam J Kimple; Brian D Thorp Journal: J Neurol Surg B Skull Base Date: 2021-12-17
Authors: Bradley R Hall; Katherine L Billue; Heidi Hon; Stacey E Sanders; Stephan Barrientos; Laura E Flores; Thomas Nicholas; Valerie Shostrom; Bria Meyer; Perry J Johnson Journal: Plast Reconstr Surg Glob Open Date: 2020-12-21
Authors: Beatrice C Go; Cammille C Go; Kevin Chorath; Alvaro Moreira; Karthik Rajasekaran Journal: World J Otorhinolaryngol Head Neck Surg Date: 2022-05-09