The Effect of Sphenopalatine Ganglion Block on the Postoperative Pain in Patients Undergoing Septorhinoplasty

Opioid-Sparing Pain Control after Rhinoplasty: Updated Review of the Literature

Rhinoplasty is one of the most performed elective surgeries, and given the opioid crisis, increasing research and studies are focused on successful pain control with multimodality opioid-sparing techniques, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentin. Although limiting overuse of opioids is critical, this cannot be at the expense of inadequate pain control, particularly as insufficient pain control can be correlated with patient dissatisfaction and the postoperative experience in elective surgery. There is likely significant opioid overprescription, as patients often report taking less than 50% of their prescribed opioids. Furthermore, excess opioids provide opportunities for misuse and opioid diversion if not disposed of properly. To optimize postoperative pain control and minimize opioid requirements, interventions must occur at the preoperative, intraoperative, and postoperative time points. Preoperative counseling is imperative to set expectations for pain and to screen for predisposing factors for opioid misuse. Intraoperatively, use of local nerve blocks and long-acting analgesia in conjunction with modified surgical techniques can lead to prolonged pain control. Postoperatively, pain should be managed with a multimodal approach, incorporating acetaminophen, NSAIDs, and potentially gabapentin with opioids reserved for rescue analgesia. Rhinoplasty represents a category of short-stay, low/medium pain, and elective procedures highly susceptible to overprescription and consequently, are readily amenable to opioid minimization through standardized perioperative interventions. Recent literature on regimens and interventions to help limit opioids after rhinoplasty are reviewed and discussed here.

The analgesic efficacy of ketamine for septorhinoplasty: a meta-analysis study

BACKGROUND

The analgesic efficacy of ketamine supplementation was not well-established for septorhinoplasty and this meta-analysis aimed to compare ketamine supplementation with placebo for the postoperative pain control of septorhinoplasty.

METHODS

We systematically searched several databases, including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of ketamine supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by random effect model.

RESULTS

Five RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, ketamine supplementation was associated with significantly decreased pain scores at 30 min (SMD = - 3.84; 95% CI = - 6.73 to - 0.96; P = 0.009), pain scores at 1 h (SMD = - 2.70; 95% CI = - 3.79 to - 1.61; P < 0.00001), pain scores at 2 h (SMD = - 1.83; 95% CI = - 3.01 to - 0.64; P = 0.003), rescue analgesics (OR = 0.08; 95% CI = 0.04 to 0.17; P < 0.00001), but unraveled no obvious impact on pain scores at 4 h (SMD = - 1.13; 95% CI = - 3.37 to 1.12; P = 0.32) or the incidence of nausea and vomiting (OR = 0.71; 95% CI = 0.30 to 1.72; P = 0.45).

CONCLUSIONS

Ketamine supplementation was effective to improve pain relief after septorhinoplasty.

The analgesic efficacy of pregabalin versus placebo for septorhinoplasty: A meta-analysis

BACKGROUND

The analgesic efficacy of pregabalin supplementation for septorhinoplasty remains elusive. This meta-analysis was conducted to compare pregabalin supplementation with placebo for the postoperative pain control of septorhinoplasty.

METHODS

We systematically searched several databases including PubMed, EMbase, Web of Science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of pregabalin supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by fixed or random-effect model based on the heterogeneity.

RESULTS

Seven RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, pregabalin supplementation was associated with significantly decreased pain scores at 1 h (standard mean difference [SMD] = -1.45; 95% confidence interval [CI] = -2.43 to -0.47; P = .004), pain scores at 2 hours (SMD = -1.01; 95% CI = -1.83 to -0.20; P = .02), pain scores at 6 hours (SMD = -1.00; 95% CI = -1.47 to -0.54; P < .0001), number of rescue analgesics (odd ratio [OR] = 0.18; 95% CI = 0.08-0.39; P < .0001) and analgesic consumption (SMD = -2.78; 95% CI = -5.05 to -0.51; P = .02), but unraveled no obvious impact on the incidence of nausea and vomiting (OR = 0.55; 95% CI = 0.24-1.27; P = .16).

CONCLUSIONS

Pregabalin supplementation was effective to improve pain relief after septorhinoplasty.

Ensuring the effectiveness and safety of peripheral blockades

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade.