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

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