xRead - Nasal Obstruction (September 2024) Full Articles

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TABLE XII-4 Evidence for non-opioid analgesics following sinus surgery Study Year LOE Design Study Groups Clinical Endpoint Conclusions Acetaminophen Tyler 1865 2017 2 Prospective, DB RCT Acetaminophen 1 gm IV (31) Saline IV (29) VAS at 15, 30, 45, and 60 minutes, and 2, 12, and 24 hours Rescue morphine consumption in first 6 hours Adverse effects Patient satisfaction Inconclusive results. The data suggest that perioperative IV acetaminophen may reduce immediate post-op pain and opioid requirements compared to placebo. Koteswara 1864 2014 2 Prospective, DB RCT Acetaminophen 1 gm IV, 15 minutes before induction (20) Acetaminophen 1 gm IV at the end of surgery (19) VAS Time to first analgesic requirement Total analgesic consumed in 24hours Pre-emptive IV acetaminophen provided effective and reliable postoperative analgesia after ESS compared to intraoperative paracetamol. Kemppainen 1863 2006 2 Prospective, DB RCT Acetaminophen 1 gm IV (36) Saline IV (38) NRS Time to oxycodone use Total oxycodone use Need for rescue analgesia Acetaminophen provides adequate pain relief in most patients, but may be insufficient by itself. Kemppainen 1862 2007 3 a Prospective, DB RCT Scheduled Return to normal daily activities NSAIDs

Scheduled acetaminophen for 5 days after surgery leads to effective pain control without the need for opioid analgesics.

Ketorolac IV is a safe analgesic in the setting of primary ESS without increased risk of

hemorrhage or acute blood-loss anemia. It provided similar analgesia to fentanyl IV.

Postoperative VAS 0, 30, 60 minutes

Supplemental analgesia POD 1, and POD 7 questionnaire

Hemoglobin levels; bleeding

As needed (PRN) acetaminophen 665mg (40) Ketorolac 30 mg IV (16) Fentanyl 25 μ g IV(18)

acetaminophen 2 tablets 665 mg, 3 times daily (38)

Moeller 1868 2012 2 Prospective, DB RCT