Effect of an Enhanced Recovery after Surgery Protocol in Postoperative Pain and Opioid Consumption after Rhinoplasty

Enhanced recovery after surgery (ERAS) protocols reduce opioid exposure in many surgical fields, but their impact on rhinoplasty has not been studied.

To compare postoperative pain control and opioid use during the first week after open septorhinoplasty among patients treated with a traditional hydrocodone/oxycodone and patients treated in an ERAS pathway, as measured by patient-reported pain score and opioid use.

Retrospective cohort study of open septorhinoplasty patients before and after ERAS implementation. Cohort I received hydrocodone/oxycodone with nonstandardized perioperative management. Cohort II followed a standardized ERAS pathway with tramadol, Celebrex, prednisone, and acetaminophen. Pain scores and opioid consumption were compared.

Fifty-one patients were studied (n = 24 and n = 27, respectively). The average age was 37.6 (SD 14) and 35.4 (SD 10.7), respectively. In cohort I, 54% were female and 46% male, and in cohort II, 67% were female and 33% were male. Mean pain scores were lower in cohort II (3.8 vs. 5.9, p = 0.0007). Total morphine milligram equivalent use was lower in cohort II (37.8 vs. 46.3, p = 0.51).

A multi-modality ERAS protocol after open septorhinoplasty reduced postoperative pain during the first week after surgery, without increasing opioid usage, compared to traditional pain management with opioids.