Acute Pain Management Following Facial Plastic Surgery

Clinical Efficacy of 830 nm LED Photobiomodulation Therapy on Postoperative Blepharoplasty Complications

BACKGROUND

Blepharoplasty is the most prevalent cosmetic surgery procedure in Asia. There are three main types of blepharoplasty procedures: incision, threading, and spotting, with incision being the most common procedure. However, after incisional surgery, patients experience prolonged periorbital swelling, bruising, and scarring. In order to help patient reduce periorbital swelling and erythema and ease the discomfort. In this research, the authors introduce a photobiomodulation therapy and to investigate the efficacy and safety of 830 nm light-emitting diode (LED) phototherapy in improving complications after incisional blepharoplasty.

METHOD

Participants were randomly assigned 830 nm LED phototherapy (novel care model) or traditional care model for postoperative care. The efficacy of different care measures on postoperative complications after incisional blepharoplasty was assessed using swelling score, pain score (VAS), wound healing grading, and anxiety scale (SAS).

RESULTS

A total of 145 patients were included, including 73 in the novel care model group and 72 in the traditional care model group. The new care model based on 830 nm LED phototherapy could significantly improve the swelling, pain, wound healing, and anxiety self-assessment scale assessment of the patients compared with the traditional care model, and the difference was statistically significant (P<0.05).

CONCLUSION

Photobiomodulation using 830 nm LED can markedly reduce postoperative swelling and pain, promote effective wound healing, lessen postoperative patient anxiety, and have no negative side effects.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical and surgical factors associated with opioid refill rates following septorhinoplasty

BACKGROUND

Septorhinoplasty is one the most common class of procedures performed worldwide, and opioids are frequently prescribed for post-operative pain [1].

OBJECTIVE

The objective of this study was to examine the rate of post-operative opioid prescription refills following septorhinoplasty.

METHODS

This study was a case-control study of patients who underwent septoplasty and other secondary concomitant procedures.

RESULTS

Of the 249 patients included in this study, the majority of patients (94.8%) were prescribed 12 tablets of hydrocodone-acetaminophen 5 mg - 325 mg and only 31 patients (13.3%) received refills. The presence of osteotomies and history of prior opioid use were associated with refills. Nasal valve repair type, open versus closed approach, and presence of autologous auricular cartilage graft harvest were not.

DISCUSSION

Our study highlights factors that surgeons should consider when prescribing opioids after septorhinoplasty. Twelve tablets of an opioid are likely sufficient for the majority of patients, but if osteotomies are performed or the patient has a history of prior opioid use, more may be indicated to avoid the need for refills. Additional narcotics are not necessary for an open approach or for patients in which auricular cartilage is needed.

Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial

Introduction  Septorhinoplasty operates on the nose's bone and cartilage and is ensued by severe postoperative pain. Objective  The objective of this study is to evaluate the effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methods  A total of 150 patients undergoing septorhinoplasty were randomly assigned into 3 groups with 50 patients in each group. The control group (group A) was administered 100 ml saline solution; the paracetamol group (group B) was administered 1,000 mg of IV paracetamol in 100 ml of saline solution; and the ibuprofen group (group C) was administered 800 mg of IV ibuprofen in 100 ml of saline solution before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using the visual analogue scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results  In comparison with group A, the score in the VAS of groups B and C was statistically lower in all the time intervals ( p  < 0.05). In the 1 st and 6 th hours postoperatively, group C's score in the VAS in was lower than that of group B ( p  < 0.05). In the control group, total opioid consumption was highest in all time intervals ( p  < 0.05). In group C, total opioid consumption was significantly lower than in group B in the 0 to 6 and 6 to 12 hours intervals. ( p  < 0.05). Conclusion  The single-dose preemptive administration of ibuprofen has a more profound postoperative analgesic effect than paracetamol in the first 6 hours after septorhinoplasty. After the first 6 hours postsurgery, there is no difference between ibuprofen and paracetamol in terms of analgesic effect.

Guided Mindfulness Meditation for Pain Control After Septorhinoplasty: A Randomized-Controlled Pilot Study

Background: Mindfulness meditation has been shown to alleviate pain and may be an appealing adjunctive pain management option. Objective: To compare measures of pain, mindfulness, and opioid usage, and collect evaluative feedback among patients undergoing septorhinoplasty with and without guided meditation. Methods: Patients undergoing septorhinoplasty were randomized to online-guided meditation postoperative days 0-3 versus standard care; all received the same pain medications. Primary outcome measures included pain intensity, opioid consumption, mindfulness scores, and evaluative feedback. Results: Twenty-one patients received guided meditation and 24 received standard care. No significant difference in opioid consumption or pain scores was seen with the exception of higher opioid use in patients with intranasal splints in the standard care group. Twenty out of 21 patients provided evaluative feedback; all recommended mindfulness meditation to friends undergoing nasal surgery, 90% reported it was beneficial, 85% believed it eased pain/discomfort, and 80% believed it aided with sleep. Conclusion: Although no objective difference was found in opioid consumption or pain scores, most patients reported that guided mindfulness meditation was beneficial to their recovery following septorhinoplasty.

Postoperative Pain and Opioid Use after Facial Feminization Surgery

The objective of this study is to characterize surgical pain after facial feminization surgery (FFS) and delineate postoperative opioid usage. It is a retrospective cohort study. It was performed in a multicenter integrated health care system. Electronic medical records were reviewed for patient demographic characteristics, medical history, pain medication prescriptions, and responses to a postoperative pain survey. Student's t-test and the Mann-Whitney U-test were used for bivariate analysis. Fisher's exact tests were used for categorical data. Seventy-four patients who underwent FFS were included. The mean (standard deviation) reported "average" postoperative pain score was 4.3 (2.3) out of 10. A total of 58% of patients reported pain lasting 5 or fewer days after surgery. The severity and duration of postoperative pain was similar between patients who underwent partial-FFS or full-FFS. A total of 68% of patients required fewer than 15 opioid tablets. There were no significant differences in the quantity of opioids prescribed or used between patients who underwent partial-FFS or full-FFS. Older age and premorbid mood disorder did not correlate with greater severity/duration of pain or number of opioids used after surgery. Most patients required fewer than 15 opioid tablets after surgery and experienced less than a week of postoperative pain. Patients undergoing full-FFS did not appear to experience significantly greater pain than those undergoing fewer procedures. Older age and premorbid mood disorder were not predictors of worse pain outcomes or greater opioid utilization.