NSAIDs after sinus surgery tied to reduced opioid use

  • Wu AW & al.
  • Int Forum Allergy Rhinol
  • 13 Dec 2019

  • International Clinical Digest
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Takeaway

  • Patients undergoing functional endoscopic sinus surgery (FESS) who received ibuprofen and paracetamol as first-line treatment for pain, with opioid as rescue treatment, reported less pain and used fewer opioid pills than patients who received opioids for pain management with NSAIDs.

Why this matters

  • Clinicians had been hesitant to rely on NSAIDs for pain relief after otolaryngologic surgeries because of concerns about bleeding complications, but NSAID-first users in this study reported no bleeding issues.

Study design

  • Prospective cohort study on patients undergoing FESS/other endoscopic nasal surgeries (74 without NSAIDs; 101 with NSAIDs).
  • Funding: None disclosed.

Key results

  • The overall mean pain visual analogue scale (VAS) scores were 3.12 in the non-NSAID group and 2.33 in the NSAID group (P=.006).
  • Pain VAS scores decreased significantly over the week (P<.0001>
  • The pain VAS score was highest on day 1 postoperation (day 1 vs day 2, P=.015; day 1 vs days 2-7, P<.0001>
  • 147 patients who completed the pain diary had mean pain VAS scores of:
    • 2.44 (overall); and
    • 3.05 (average from days 1-7).
  • The average number of total opioid pills without NSAIDs vs with NSAIDs was 6.94 vs 3.77 (P=.018).

Limitations

  • Pain levels could not be compared between a full FESS and a single sinus surgery.

Coauthored with Chitra Ravi, MPharm