Both a non-narcotic and a narcotic pain medication provided the same relief after nasal and sinus surgery in a randomized, controlled study conducted by physician researchers in the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School at UTHealth. The results of the study were published in the International Forum of Allergy and Rhinology.
“This is good news for our patients who undergo endoscopic sinus surgery and septoplasty because of the general reluctance to prescribe opioids for postoperative pain, given their potential for abuse,” says Martin J. Citardi, MD, professor and chair of the Department of Otorhinolaryngology. “Our study demonstrated that NSAIDs are equally effective in controlling postoperative pain.”
Endoscopic sinus surgery (ESS) and septoplasty are commonly performed procedures without standardized postoperative pain regimens. NSAIDs previously have been shown to reduce or eliminate the need for opioid pain medications after otolaryngologic surgeries, but prospective validation of this finding was lacking.
In the study, the researchers compared the efficacy of diclofenac sodium, an NSAID, to hydrocodone/acetaminophen, an opioid, following ESS with or without septoplasty. Seventy-four of 100 participating patients completed a visual analog scale, a validated, subjective measure for acute and chronic pain on a continuum between “no pain” and “worst pain,” on postoperative days 1, 2, 3, and 5 following ESS. While patients undergoing septoplasty at the time of ESS reported significantly higher average pain scores, treatment with the NSAID versus the opioid did not statistically impact pain scores on any postoperative day. No cases of nose bleeding requiring an emergency room visit or a return to the operating room were reported.
Alok Saini, MD, who completed fellowship training in neurorhinology and advanced endoscopic sinus surgery at the Texas Sinus Institute in the Department of Otorhinolaryngology at McGovern Medical School and is now a faculty member at the University of Kentucky, was the lead author for the study. He joined the Division of Rhinology and Anterior Skull Base Surgery in the University of Kentucky Department of Otolaryngology in 2018, after completing his training under the guidance of Dr. Citardi; Amber Luong, MD, PhD, professor and vice chair for research; and William C. Yao, MD, assistant professor and director of the otorhinolaryngology residency program, who together serve as co-directors of the UTHealth Rhinology and Skull Base Fellowship.