The Safety and Efficacy of Perioperative NSAIDs in Rhinoplasty-A Systematic Review and Meta-Analysis

The opioid epidemic has highlighted the value of multimodal analgesia, with NSAIDs showing promise in reducing narcotic use and managing postoperative pain. While concerns about NSAIDs increasing bleeding risk remain debated, particularly in facial surgeries like rhinoplasty, this study pools data to systematically evaluate the safety and efficacy of NSAIDs for this procedure.

PubMed, Cochrane, and Web of Science.

Databases were queried for English-language studies containing original data on perioperative NSAID administration in rhinoplasty patients between 1990 and 2024. Primary outcomes reviewed were postoperative pain, nausea and vomiting (PONV), bleeding, and narcotic use. Studies without outcome measures were excluded. Two investigators independently reviewed manuscripts and performed quality assessment.

Of 660 abstracts identified, 8 studies met eligibility: 7 randomized controlled trials and 1 cohort study. Six underwent meta-analysis, including 470 patients (260 receiving NSAIDs, 210 receiving placebo). Rhinoplasty patients receiving perioperative NSAIDs demonstrated significantly lower postoperative pain scores (standard mean difference [SMD] = 1.20 [95% CI: 2.01-0.39, p = 0.004]) and total opioid consumption (SMD = 1.43 [95% CI: 2.23-0.62, p = 0.0005]). PONV was 27% less likely in the NSAID group (odds ratio [OR] = 0.27 [95% CI: 0.17-0.44, p = 0.00001]). No significant difference in bleeding existed between groups (OR = 1.28 [95% CI: 0.34-4.87, p = 0.71]). Quality assessment indicated a low risk of bias for all but two studies.

This systematic review and meta-analysis indicates that NSAIDs are a safe, effective first-line analgesic for rhinoplasty, without increasing postoperative bleeding risk. NSAID use significantly reduces postoperative narcotic usage and PONV. Further research is needed to examine alternative agents and dosing regimens.

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