The benefits and risks of non‐steroidal anti‐inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta‐analysis

Background Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically...

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Published in:International forum of allergy & rhinology 2023-09, Vol.13 (9), p.1738-1757
Main Authors: Lee, Daniel J., Grose, Elysia, Brenna, Connor T. A., Philteos, Justine, Lightfoot, David, Kirubalingam, Keshinisuthan, Chan, Yvonne, Palmer, James N., Adappa, Nithin D., Lee, John M.
Format: Article
Language:English
Subjects:
Analgesia
Clinical trials
endoscopic sinus surgery
Epistaxis
Inflammation
Meta-analysis
Nausea
Nonsteroidal anti-inflammatory drugs
NSAIDs
Observational studies
Pain management
Pain perception
Paranasal sinus
Patients
rhinoplasty
Surgery
Vomiting
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Summary:Background Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting). Results Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22). Conclusion Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.
ISSN:2042-6976
2042-6984
DOI:10.1002/alr.23140