A Long-Acting Combination Nerve Block in Rhinoplasty to Minimize Postoperative Opioid Use

Minimizing the use of narcotics has been a primary concern in rhinoplasty in order to limit severe side effects and complications associated with opioid use, with addiction being of particular concern. The senior author previously described a bupivacaine nerve block technique in rhinoplasty that significantly reduced postoperative recovery times as well as narcotic, antiemetic, and benzodiazepine use. The aim of this study was to see whether a more potent nerve block composed of bupivacaine with the addition of dexmedetomidine and dexamethasone will result in the patient's avoidance of narcotics following rhinoplasty. A retrospective analysis was conducted on a total of 357 consecutive patients who underwent primary rhinoplasty with a single surgeon. Patients were administered an updated nerve block with a combination of bupivacaine, dexmedetomidine, and dexamethasone. The length of recovery time and use of postoperative medications were collected. In this cohort, 355 of 357 patients avoided postoperative opioids with a 99.4% success rate. No patients experienced side effects from the nerve block. The use of a combination nerve block with bupivacaine, dexmedetomidine, and dexamethasone can lead to successful reduction of postoperative opioid use. Future studies will compare the use of postoperative medications and duration of recovery time between patients who were administered this updated combination nerve block and those who did not receive the combination nerve block. Level of Evidence: 4 (Therapeutic).