April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Of the 22 patients who had rhinoplasty, 19 also had a septoplasty, including concurrent endoscopic sinus surgery in one. Twelve patients were female, and 10 were male, and their average age was 38.2 14.8 years (range, 24 – 68 years). Endonasal approaches were used in 13 cases, whereas an external approach was used in the remaining nine cases. Two patients were prescribed codeine/acetaminophen 30/300, whereas 19 patients were given oxycodone/acetaminophen 5/325; one patient refused any opioid prescription. The pain reported by rhinoplasty patients ranged from 0 to 88 on the VAS scale (Fig. 1). The mean number of opioid tablets used was 4.4 4.0 (range, 0 – 14), with a mean total MMEs used of 28.7 34.1 (Fig. 2). These patients averaged 7,471 1,009 mg of acetamino- phen through POD 14 (Fig. 3). Rhinoplasty patients reported a VAS score at least 40 for 1.9 1.9 days and at least 30 for 2.9 2.7 days. All patients in both groups had excess opioids at the end of the follow-up period. Statistical analysis showed no differences in total MMEs, number of opioid tablets consumed, or in overall VAS pain scores between septoplasty and rhinoplasty patients. Furthermore, there was no difference in these measurements between patients undergoing external ver- sus endonasal approaches, between patients treated or not treated with nasal bone osteotomies, or based on weight or body mass index. There was a weak trend toward statistical difference in the number of days with a VAS score of at least 30 ( P = .07). There was a statistically sig- ni fi cant difference between the septoplasty and rhinoplasty groups in the amount of postoperative acetaminophen used ( P = .0112). There was no difference in acetaminophen use in rhinoplasty patients based on external versus endonasal approach or whether or not patients were treated with osteotomies.

before returning their reports by mail. Morphine milligram equiv- alents (MMEs) were calculated using appropriate conversion fac- tors. 1 Operative reports were reviewed for technique speci fi cs; the New York State Prescription Monitoring Program Registry 2 was also consulted to ensure patients received no other opioid prescrip- tions for 3 months before and during the 2-week postoperative period. All responses were entered into an Excel spreadsheet (Microsoft Excel for Mac 2011 version 14.6.2; Microsoft Corp., Redmond, WA). Statistical analysis was performed using Prism 8 for macOS version 8.0.0 (GraphPad Software, Inc., San Diego, CA). Two-tailed unpaired t tests were performed to assess rela- tionship. This study was approved by the Weill Cornell Medical College Institutional Review Board. RESULTS Forty-four patients were enrolled and completed ini- tial questionnaires, and 36 completed and returned their postoperative logs. Fourteen patients who underwent sep- toplasty with or without inferior turbinate reduction sur- gery and 22 patients who underwent functional and/or cosmetic rhinoplasty, with or without septoplasty and tur- binate reduction, were available for review. One of three surgeons performed the septoplasty, whereas all rhinoplas- ties were performed by one surgeon. One septoplasty patient reported using short-acting opioids preoperatively and was excluded from the analysis. All 13 septoplasties were performed endonasally. Eleven were male and two were female; the average age was 44.3 15.7 years (range, 18 – 75 years). Three patients were prescribed codeine/acetaminophen 30/300, whereas the re- maining 10 patients were given oxycodone/acetaminophen 5/325. The pain reported by septoplasty patients ranged from 0 to 78 on the VAS scale. The mean number of opioid tablets used was 4.1 4.4 (range, 0 – 15), with a mean total MMEs used of 28.7 34.1. These patients averaged 2,781 585 milligrams of acetaminophen through post- operative day (POD) 14; they reported a VAS score of at least 40 for 0.9 1.1 days and at least 30 for 1.4 1.1 days.

DISCUSSION The Centers for Disease Control and Prevention has estimated that 116 Americans died every day in 2016 in

Fig. 1. Mean daily patient-reported postoperative pain scores for patients undergoing septoplasty and rhinoplasty. VAS = visual analog scale. [Color fi gure can be viewed in the online issue, which is available at www.laryngoscope.com.]

Laryngoscope 00: 2019

Sclafani et al.: Postoperative Pain After Septorhinoplasty

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