No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol

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

Research output: Contribution to journalArticlepeer-review

Abstract

Background: From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. Methods: A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients. Results: Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3-81), and median total requirement was 20 mg morphine equivalents (range 7.5-85). Protocol compliance inversely correlated to opioid use (P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1-5 (P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups. Conclusion: This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction.

Original languageEnglish (US)
Article numbere3305
JournalPlastic and Reconstructive Surgery - Global Open
DOIs
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Surgery

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