Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 9/2023

05-06-2023 | Septorhinoplasty | Review Article

Pain management following septorhinoplasty surgery: evidence from a systematic review

Authors: Arman Shafiee, Razman Arabzadeh Bahri, Mohammad Mobin Teymouri Athar, Maryam Beiky, Omid Rostaii, Golshid Golpayegani, Faeze Soltani Abhari

Published in: European Archives of Oto-Rhino-Laryngology | Issue 9/2023

Login to get access

Abstract

Purpose

We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery.

Methods

Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022.

Results

Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies.

Conclusion

This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques.
Appendix
Available only for authorised users
Literature
1.
Kalmykov IK, Muradov GM, Reshetov IV, Tsymbal AA (2022) Effect of anesthesia on postoperative pain in patients after septoplasty. Dokl Biochem Biophys 503(1):93–97PubMed
2.
Pourfakhr P, Khajavi MR, Jalali A, Memari F, Etezadi F, Momeni Roochi M et al (2019) Low-dose preoperative pregabalin improves postoperative pain management in septorhinoplasty surgery: a double-blind randomized clinical trial. Eur Arch Oto-rhino-laryngol 276(8):2243–2249
3.
de Leon-Casasola OA (1996) New concepts in postoperative pain management: is there more beyond pain control? J Fla Med Assoc 83(10):695–700PubMed
4.
Caliskan E, Sener M, Kipri M, Yilmaz I, Aribogan A (2018) Comparison of the effects of intravenous dexketoprofen trometamol versus paracetamol on postoperative analgesia in patients undergoing septoplasty: a randomised double-blind clinical trial. Pak J Med Sci 34(3):546–552
5.
Yayik AM, Yildirim H, Ahiskalioglu A, Sakat MS, Ergüney ÖD, Ahiskalioglu EO et al (2019) Effects of bupivacaine versus bupivacaine plus dexamethasone-soaked nasal packing after endoscopic nasal surgery. J Craniofac Surg 30(4):1174–1177PubMed
6.
Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayik AM, Temiz A (2017) Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine 96(8):e6200PubMedPubMedCentral
7.
Sagit M, Yalcin S, Polat H, Korkmaz F, Cetinkaya S, Somdas MA (2013) Efficacy of a single preoperative dose of pregabalin for postoperative pain after septoplasty. J Craniofac Surg 24(2):373–375PubMed
8.
Newberry CI, McCrary HC, Cerrati EW (2020) The efficacy of oral celecoxib following surgical rhinoplasty. Fac Plast Surg Aesthet Med 22(2):100–104
9.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 10(1):89PubMedPubMedCentral
10.
NIO Health (2014) National heart, lung and blood Institute quality assessment tool for observational cohort and cross-sectional studies. Halth NIO
11.
Ates I, Aydin ME, Ahiskalioglu A, Ahiskalioglu EO, Kaya Z, Gozeler MS (2020) Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study. Eur Arch Otorhinolaryngol 277(4):1095–1100PubMed
12.
Ates I, Aydin ME, Celik EC, Gozeler MS, Ahiskalioglu A (2021) Perioperative intravenous low-dose ketamine infusion to minimize pain for septorhinoplasty: a prospective, randomized, double-blind study. Ear Nose Throat J 100(4):254–259PubMed
13.
Bicer C, Eskitascioglu T, Aksu R, Ulgey A, Yildiz K, Madenoglu H (2011) Comparison of preincisional infiltrated levobupivacaine and ropivacaine for acute postoperative pain relief after septorhinoplasty. Curr Ther Res Clin Exp 72(1):13–22PubMedPubMedCentral
14.
Celebi N, Cizmeci EA, Canbay O (2014) Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial. Rev Bras Anestesiol 64(5):343–349PubMed
15.
Celik EC, Kara D, Koc E, Yayik AM (2018) The comparison of single-dose preemptive intravenous ibuprofen and paracetamol on postoperative pain scores and opioid consumption after open septorhinoplasty: a randomized controlled study. Eur Arch Otorhinolaryngol 275(9):2259–2263PubMed
16.
Cicek M, Yucel A, Gedik E, Sagir O, But AK, Ersoy MO (2006) The effects of intra-operative low-dose dexmedetomidine infusion on postoperative pain in patients undergoing septorhinoplasty. Pain Clin 18(5–6):395–402
17.
Demirhan A, Akkaya A, Tekelioglu UY, Apuhan T, Bilgi M, Yurttas V et al (2014) Effect of pregabalin and dexamethasone on postoperative analgesia after septoplasty. Pain Res Treat 2014:850794PubMedPubMedCentral
18.
Dogan R, Erbek S, Gonencer HH, Erbek HS, Isbilen C, Arslan G (2010) Comparison of local anaesthesia with dexmedetomidine sedation and general anaesthesia during septoplasty. Eur J Anaesthesiol 27(11):960–964PubMed
19.
Ekmekci P, Beriat GK, Bengisun ZK, Kazbek BK, Duman P, Suer H (2013) The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations. Indian J Otolaryngol Head Neck Surg 65(1):12–15PubMed
20.
Erkul E, Babayigit M, Kuduban O (2010) Comparison of local anesthesia with articaine and lidocaine in septoplasty procedure. Am J Rhinol Allergy 24(5):e123–e126PubMed
21.
Gokce BM, Ozkose Z, Tuncer B, Pampal K, Arslan D (2007) Hemodynamic effects, recovery profiles, and costs of remifentanil-based anesthesia with propofol or desflurane for septorhinoplasty. Saudi Med J 28(3):358–363PubMed
22.
Gozeler MS, Sakat MS, Kilic K, Ozmen O, Can A, Ince I (2018) Does a single-dose preemptive intravenous ibuprofen have an effect on postoperative pain relief after septorhinoplasty? Am J Otolaryngol 39(6):726–730PubMed
23.
Gumus N (2020) Lavage with lidocaine and adrenaline mixture reduces the early side effects of septorhinoplasty. Ann Plast Surg 84(6):E29–E32PubMed
24.
Kandemir S, Pamuk A, Özel G, Gençay I, Kılıç R (2022) The efficacy of gabapentin+dexamethasone for postoperative analgesia following septoplasty: a prospective randomized placebo-controlled trial. Ann Otol Rhinol Laryngol 132:304–309PubMed
25.
Karaman E, Gungor G, Alimoglu Y, Kilic E, Tarakci E, Bozkurt P et al (2011) The effect of lidocaine, bupivacaine and ropivacaine in nasal packs on pain and hemorrhage after septoplasty. Eur Arch Oto-rhino-laryngol 268(5):685–689
26.
Koputan MH, Apan A, Oz G, Kose EA (2012) The effects of tramadol and levobupivacaine infiltration on postoperative analgesia in functional endoscopic sinus surgery and septorhinoplasty. Balkan Med J 29(4):391–394PubMedPubMedCentral
27.
Kürkçüoǧlu SS, Genç S, Tuncel U, Inançli HM, Guclu Güven D, Yazici AC (2010) Pain reducing effect of parenteral paracetamol and diclofenac after septoplasty. Duzce Med J 12(2):42–47
28.
Onal SA, Keleş E, Toprak GC, Demirel I, Alpay HC, Avci L (2006) Preliminary findings for preemptive analgesia with inhaled morphine: efficacy in septoplasty and septorhinoplasty cases. Otolaryngol Head Neck Surg 135(1):85–89PubMed
29.
Ozer AB, Erhan OL, Keles E, Demirel I, Bestas A, Gunduz G (2012) Comparison of the effects of preoperative and intraoperative intravenous application of dexketoprofen on postoperative analgesia in septorhinoplasty patients: randomised double blind clinical trial. Eur Rev Med Pharmacol Sci 16(13):1828–1833PubMed
30.
Sanli M, Gulhas N, Bilen BT, Erdogan Kayhan G, Ucar M, Aytekin AH et al (2016) The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties. Turk J Med Sci 46(3):789–794PubMed
31.
Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A et al (2008) Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth 20(2):103–108PubMed
32.
Sener M, Yilmazer C, Yilmaz I, Caliskan E, Donmez A, Arslan G (2008) Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study. Eur J Anaesthesiol 25(3):177–182PubMed
33.
Toǧrul T, Baysal Yildirim Z, Cengiz M, Çiǧdem A, San I, Kar M et al (2011) Comparison of intravenous paracetamol and tramadol for postoperative analgesia in patients with septo-rhinoplasty. Anestezi Dergisi 19(4):213–216
34.
Yener HM, Akiner U, Sari E, Erdur ZB, Tevetoglu F, Gozen ED (2022) The role of preemptive infiltration anesthesia in the management of postoperative pain following septoplasty. Int Arch Otorhinolaryngol 26:725–729
35.
Yilmaz YF, Ozlugedik S, Titiz A, Tuncay A, Ozcan M, Unal A (2008) Comparison of levo-bupivacaine and lidocaine for postoperative analgesia following septoplasty. Rhinology 46(4):289–291PubMed
36.
Frants A, Garber D, Lafer MP, Gordon SA, Markey JD, Zhang Y et al (2021) Prospective randomized trial comparing opioids versus nonsteroidal anti-inflammatory drugs for postoperative analgesia in outpatient rhinoplasty. Plast Reconstr Surg 147(1):56–62PubMed
37.
Jandali D, Barrera JE (2022) Equivocal pain scores one week after rhinoplasty: synthetic opioid versus neuropathic analgesic. Fac Plast Surg Aesth Med 24(1):69–70
38.
Marshall RV, Rivers NJ, Manickavel S, Grayson JW, Cox AJ (2021) Postoperative opioid use in rhinoplasty procedures: a standardized regimen. Fac Plast Surg 37(1):110–116
39.
Saini AT, Jiang ZY, Starr NC, Talmadge J, Schmale I, Radabaugh P et al (2022) Are nonsteroidal anti-inflammatory drugs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty? A randomized, controlled study. Int Forum Allergy Rhinol 12(7):910–916PubMed
40.
Eftekharian A, Roozbahany NA (2013) Use of intravenous steroids at induction of anesthesia for septoplasty to reduce post-operative nausea and vomiting and pain: a double-blind randomized controlled trial. Indian J Otolaryngol Head Neck Surg 65(Suppl 2):216–219PubMed
41.
Mohammadi A, Yazdani Y, Nazari H, Choubsaz M, Azizi B, Nazari H et al (2020) The effect of a single 75 mg preoperative dose of pregabalin on postoperative pain in rhinoplasty: a double-blinded, placebo-controlled randomized clinical trial. J Cranio-Maxillofac Surg 48(9):875–879
42.
Shakeri H, Mianroodi AA, Haghbin M, Khanjani N (2020) The efficacy of oral tizanidine in reducing pain after septoplasty. Tehran Univ Med J 78(3):144–149
43.
Tarogh SAH, Hadavi MR, Omidvari S, Daneshforouz MA (2015) Comparison of analgesic effects of post-operative morphine, pre-emptive and post-operative paracetamol in septorhinoplasty surgery. Galen Med J 4(2):121–125
44.
Vahabi S, Rafieian Y, Abbas ZA (2018) The effects of intraoperative esmolol infusion on the postoperative pain and hemodynamic stability after rhinoplasty. J Investig Surg 31(2):82–88
45.
Granier M, Dadure C, Bringuier S, Bonnet-Boyer MC, Ryckwaert Y, Loriaux E et al (2009) Intranasal lidocaine plus naphazoline nitrate improves surgical conditions and perioperative analgesia in septorhinoplasty surgery. Can J Anaesth 56(2):102–108PubMed
46.
Kim JH, Seo MY, Hong SD, Lee J, Chung SK, Kim HY et al (2014) The efficacy of preemptive analgesia with pregabalin in septoplasty. Clin Exp Otorhinolaryngol 7(2):102–105PubMedPubMedCentral
47.
BenDavid B, Moscona RA, Stahl S (1996) The combination of morphine with local anaesthetic in rhinoplasty - No evidence of a peripheral morphine effect. Acta Anaesthesiol Scand 40(8):892–897PubMed
48.
Bagatin T, Bagatin D, Sakic L, Sakic K (2019) Impact of local infiltration anesthesia on postoperative pain management after rhinoplasty in day care surgery. Acta Clin Croat 58:62–66PubMedPubMedCentral
49.
Aqil M, Aziz ul H, Rasheed A, Hussain A, Khan M, Al-Saeed A (2011) Is preemptive analgesic effect of ketamine dose dependent? Effect of increasing dose on post septorhinoplasty pain. Pak J Med Sci 27(3):608–612
50.
Mohsin MU, Ahmed MJ, Shahid M, Furqan A (2019) Effect of pre-emptive gabapentin on anaesthetic and analgesic requirements in patients undergoing rhinoplasty. Med Forum Mon 30(3):95–99
51.
52.
Salama ER, Amer AF (2018) The effect of pre-emptive gabapentin on anaesthetic and analgesic requirements in patients undergoing rhinoplasty: a prospective randomised study. Indian J Anaesth 62(3):197–201PubMedPubMedCentral
53.
54.
Prabhu V, Kaushik V, Rhodes S, Tay H (2007) Foam nasal packs: a prospective, randomised, patient-controlled study. Rhinology 45(3):242–247PubMed
55.
Hogg RP, Prior MJ, Johnson AP (1999) Admission rates, early readmission rates and patient acceptability of 142 cases of day case septoplasty. Clin Otolaryngol Allied Sci 24(3):213–215PubMed
56.
Gan TJ (2017) Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res 10:2287–2298PubMedPubMedCentral
57.
Kim DH, Kang H, Jin HJ, Hwang SH (2019) Effect of piezoelectric osteotomy on postoperative oedema and ecchymosis after rhinoplasty. Clin Otolaryngol 44(6):968–974PubMed
58.
Weinbroum AA, Ben-Abraham R (2001) Dextromethorphan and dexmedetomidine: new agents for the control of perioperative pain. Eur J Surg 167(8):563–569PubMed
59.
Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A (2019) Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope 129(9):2020–2025PubMed
60.
Nguyen BK, Yuhan BT, Folbe E, Eloy JA, Zuliani GF, Hsueh WD et al (2019) Perioperative analgesia for patients undergoing septoplasty and rhinoplasty: an evidence-based review. Laryngoscope 129(6):E200–E212PubMed
61.
Elsayed M, Alosaimy RA, Ali NY, Alshareef MA, Althqafi AH, Rajab MK et al (2020) Nerve block for septorhinoplasty: a retrospective observational study of postoperative complications in 24 hours. Cureus 12(2):e6961PubMedPubMedCentral
62.
63.
Moningi S, Patki A, Padhy N, Ramachandran G (2019) Enhanced recovery after surgery: an anesthesiologist’s perspective. J Anaesthesiol Clin Pharmacol 35(Suppl 1):S5-s13PubMedPubMedCentral
64.
Bartlett EL, Zavlin D, Friedman JD, Abdollahi A, Rappaport NH (2018) Enhanced recovery after surgery: the plastic surgery paradigm shift. Aesthetic Surg J 38(6):676–685
Metadata
Title
Pain management following septorhinoplasty surgery: evidence from a systematic review
Authors
Arman Shafiee
Razman Arabzadeh Bahri
Mohammad Mobin Teymouri Athar
Maryam Beiky
Omid Rostaii
Golshid Golpayegani
Faeze Soltani Abhari
Publication date
05-06-2023

Other articles of this Issue 9/2023

European Archives of Oto-Rhino-Laryngology 9/2023 Go to the issue

Otology

Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender

Miscellaneous

Dysphagia outcomes in COVID-19 patients: experiences in long-term acute care hospital (LTACH)

Short Communication

The causal association between peripheral blood eosinophils and nasal polyps: a Mendelian randomization study

Review Article

Human papillomavirus infection and non-oropharyngeal head and neck cancers: an umbrella review of meta-analysis

Review Article

Assessment of the Eustachian tube: a review

Head and Neck

Clinical practice guidelines for management of head and neck squamous cell carcinoma of unknown primary: an AGREE II appraisal