BACKGROUND: Opioids remain the primary modality for postoperative pain management in sinonasal procedures. This study aims to assess whether a long-duration pain block decreases the need for opioid pills postoperatively.
METHODS: We conducted a randomized, controlled clinical trial in subjects undergoing bilateral endoscopic sinus surgery (ESS). Patients in the experimental group received a local anesthetic block (10-mL of 0.5% bupivacaine with 1:200,000 epinephrine and 2 mg of dexamethasone) targeting the supraorbital, supratrochlear, infraorbital, and sphenopalatine nerves. The control group received no injection. Subjects completed a diary documenting pain scores (VAS) and opioid consumption for 10 days. Demographics, medical history, and additional surgical components (septoplasty, turbinate reduction, modified medical maxillectomy, Draf III) were recorded. Diaries were submitted, and pill counts were conducted on postoperative day (POD)-10.
RESULTS: Thirty-one patients (42.9 years, 48.4% female) completed the study (16 treatment and 15 control). Demographics and procedure types were not significantly different between cohorts. The average opioid tablets consumed did not differ between control (9.87+/-10.86) and treatment groups (10.63+/-8.91). Similarly, pain scores were not significantly different between groups. Consumption peaked on POD1 at 2.1 pills and dropped <1 pill by POD4. Pain scores were higher for women than men.
CONCLUSION: While this long-acting pain block did not decrease narcotic use, results show that regardless of surgical procedure, opioids could be limited to an average of 12 pills to achieve sufficient analgesia after ESS.