Facial Plast Surg 2020; 36(03): 290-296
DOI: 10.1055/s-0040-1712474
Original Research
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pain after External and Endonasal Septorhinoplasty—A Propensity Score Matching Analysis

Magdalena Gostian
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
,
Johannes Loeser
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
,
Ludwig Heindl
2   Department of Ophthalmology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
,
3   Department of ENT, Head and Neck Surgery, Erlangen University Hospital, Erlangen, Germany
› Author Affiliations
Funding There was no financial support and no funding during the preparation of this article.
Further Information

Publication History

Publication Date:
08 June 2020 (online)

Abstract

Guidelines for pain management following septorhinoplasty are lacking, leading to a wide range of therapy regimes even including opioid medication. Thus, the presented study strived to investigate and compare postoperative pain intensities after external and endonasal septorhinoplasty and evaluate whether pain perception is potentially related to patient satisfaction with the aesthetic result. In addition, the effectiveness of an escalating pain treatment protocol was evaluated sparing the necessity of opioid medication. This retrospective study performed at a tertiary referral medical center includes two well-balanced groups of 54 patients each created by propensity score matching out of a total of 161 patients following external or endonasal functional septorhinoplasty performed by a single surgeon between October 1, 2011 and March 31, 2017. Pain intensity was assessed using the visual analogue scale (0–10) on the first three postoperative days (PODs) alongside with the evaluation of the analgesic score. Patients' self-reported outcome was measured with the Utrecht questionnaire, preoperatively, and 3 and 12 months, postoperatively. Postoperative mean pain sensations were similarly high following the external and endonasal approach (F (2;190) = 2.166, p = 0.118) followed by a linear decrease over the first three PODs (F (2;190) = 16.84, p < 0.001). Pain sensations were not related to the duration of surgery, gender, patients' age, revision surgery, and the preoperative and postoperative assessment of the nasal appearance. The consumption of metamizole (F (1,76;172,15) = 2.83, p = 0.065) and ibuprofen (F (2;196) = 1.037, p = 0.356) were similarly high regardless of the surgical approach. Accordingly, both the endonasal and the external approaches led to comparable postoperative pain intensities and analgesic scores. Pain was treated effectively using a standardized escalating pain treatment protocol sparing the administration of opioids. Pain was not related to patient satisfaction with the nasal appearance pre- and postsurgery.

 
  • References

  • 1 DGÄPC-STATISTIK 2017. Zahlen, Fakten Und Trends Der Ästhetisch-Plastischen Chirurgie. Available at: https://www.dgaepc.de/wp-content/uploads/2017/11/DGAEPC-Statistik_2017.pdf . Accessed May 5, 2019
  • 2 Adamson PA, Galli SKD. Rhinoplasty approaches: current state of the art. Arch Facial Plast Surg 2005; 7 (01) 32-37
  • 3 Berghaus A. Modern rhinoplasty: is there a place for the closed approach?. Facial Plast Surg 2016; 32 (04) 402-408
  • 4 Sener M, Yilmazer C, Yilmaz I, Caliskan E, Donmez A, Arslan G. Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study. Eur J Anaesthesiol 2008; 25 (03) 177-182
  • 5 Szychta P, Antoszewski B. Assessment of early post-operative pain following septorhinoplasty. J Laryngol Otol 2010; 124 (11) 1194-1199
  • 6 Wittekindt D, Wittekindt C, Schneider G, Meissner W, Guntinas-Lichius O. Postoperative pain assessment after septorhinoplasty. Eur Arch Otorhinolaryngol 2012; 269 (06) 1613-1621
  • 7 Iverson RE, Lynch DJ. ; ASPS Committee on Patient Safety. Practice advisory on pain management and prevention of postoperative nausea and vomiting. Plast Reconstr Surg 2006; 118 (04) 1060-1069
  • 8 Meißner W, Komann M, Erlenwein J, Stamer U, Scherag A. the quality of postoperative pain therapy in German hospitals. Dtsch Arztebl Int 2017; 114 (10) 161-167
  • 9 Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 2002; 95 (03) 627-634
  • 10 Glowacki D. Effective pain management and improvements in patients' outcomes and satisfaction. Crit Care Nurse 2015; 35 (03) 33-41 , quiz 43
  • 11 Chisholm E, Jallali N. Rhinoplasty and septorhinoplasty outcome evaluation. Ear Nose Throat J 2012; 91 (03) E10-E14
  • 12 Rhee JS, McMullin BT. Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. Arch Facial Plast Surg 2008; 10 (03) 194-207
  • 13 Lohuis PJFM. Advanced Caucasian and Mediterranean Rhinoplasty. Amsterdam, The Netherlands: Kugler Publications; 2014: 110
  • 14 Lohuis PJFM, Faraj-Hakim S, Knobbe A, Duivesteijn W, Bran GM. Split hump technique for reduction of the overprojected nasal dorsum: a statistical analysis on subjective body image in relation to nasal appearance and nasal patency in 97 patients undergoing aesthetic rhinoplasty. Arch Facial Plast Surg 2012; 14 (05) 346-353
  • 15 Barone M, Cogliandro A, Di Stefano N, Tambone V, Persichetti P. A systematic review of patient-reported outcome measures after rhinoplasty. Eur Arch Otorhinolaryngol 2017; 274 (04) 1807-1811
  • 16 Lohuis PJFM, Hakim S, Duivesteijn W, Knobbe A, Tasman A-J. Benefits of a short, practical questionnaire to measure subjective perception of nasal appearance after aesthetic rhinoplasty. Plast Reconstr Surg 2013; 132 (06) 913e-923e
  • 17 Spiekermann C, Rudack C, Stenner M. Reliability and validity of the German version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (D-OAR). Eur Arch Otorhinolaryngol 2017; 274 (11) 3893-3898
  • 18 Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 2008; 27 (12) 2037-2049
  • 19 Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A. Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope 2019; 129 (09) 2020-2025
  • 20 Kuss O, Blettner M, Börgermann J. Propensity score: an alternative method of analyzing treatment effects. Dtsch Arztebl Int 2016; 113 (35-36): 597-603