Pain management following septorhinoplasty surgery: evidence from a systematic review

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.