A narrative review of opioid alternatives in rhinoplasty: a multifaceted approach, review and protocol

Abstract

Background and Objective: Alternative and non-addictive options for pain management and sedation are crucial to examine in order to reduce opioid use perioperatively. Pain management often presents a challenge for physicians as they must balance two differing purposes: efficiently moderating pain and anesthesia and minimizing chronic opioid use. Rhinoplasty, surgery to change the shape of the nose for cosmetic, functional, or both purposes, can cause the patient pain subsequent to the operation. There are many avenues to reduce pain from rhinoplasty operations, and each is addressed in this journal. Methods: Finding an efficient non-opioid alternative is currently achievable with the vast growing literature available. A non-systematic review of literature was conducted using PubMed and Google Scholar to establish findings and discussions. The search was submitted to an inclusion criterion of studies in English as well as studies published no later than 1983. Key Content and Findings: The literature review discusses a designed multimodal approach to a protocol for analgesia post rhinoplasty. The most common procedure discussed for a multimodal approach is utilizing a drug category like non-steroidal antidepressant drugs (NSAIDs) with a lower dosage of opioids. The presented analysis further encapsulates alternatives to opioids that can ameliorate surgical pain. The alternatives can often be associated with opioid sparing effects, associated with reduced common side effects like nausea and vomiting. Furthermore, every pain management protocol must be created specific to each patient where the drug course is adjusted in relation to medical history and any medical complications. Conclusions: For rhinoplasty, there are many alternatives to the traditional pain management regimes that include opioids. The study has concluded through its own implementation that use of non-opioid medications and treatments can be just as if not more effective than outdated approaches. Through Dr. Anil R. Shah’s pain management protocol, which includes a facial nerve block and non-opioid medications, his patients are able to leave the operating room and return to their normal daily activities within a day or two following their surgery.