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Diclofenac Sodium Not Inferior to Hydrocodone/Acetaminophen for Postoperative Pain After Endoscopic Sinus Surgery

by Linda Kossoff •

Are nonsteroidal anti-inflammatory drugs (NSAIDs) effective enough to reduce or remove the need for opioids to control postoperative pain after functional endoscopic sinus surgery (ESS) and septoplasty?

BOTTOM LINE

Diclofenac sodium may be non-inferior to hydrocodone/acetaminophen (APAP) in controlling postoperative pain after ESS with or without septoplasty in opioid-naïve patients without pre-existing pain conditions.

BACKGROUND: ESS and septoplasty are commonly performed procedures without standardized postoperative pain regimens. There is reluctance to prescribe opioids for postoperative pain given their potential for abuse. NSAIDs may be able to reduce or remove the need for opioids after otolaryngologic surgeries, but prospective validation is lacking.

STUDY DESIGN: Randomized, controlled study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Kentucky, Lexington, Ky.

SYNOPSIS: Researchers recruited patients with chronic rhinosinusitis or recurrent acute sinusitis who were offered ESS with or without septoplasty between April 1, 2018, and July 1, 2020. Patients were randomized into two treatment groups to receive, as needed, either diclofenac sodium 50 mg orally three times daily or APAP 10–325 mg every four to six hours. They were given a 100-mm visual analog pain scale at postoperative days (PODs) 1, 2, 3, and 5 following ESS. Of 100 patients, 74 completed pain scores. The highest pain scores were reported on POD 1, with a higher but not statistically significant mean average score in the APAP group. Score between the two groups did not differ significantly on PODs 2 to 5. Authors noted that despite some otorhinolaryngologists’ reluctance to prescribe NSAIDs postoperatively due to the theoretical risk of bleeding, past reports support their safety and efficacy. Moreover, the use of diclofenac sodium in this study was not associated with significant bleeding requiring return to the emergency or operating room. Study limitations included the exclusion of patients with specific conditions and medication use.

CITATION: Saini AT, Jiang ZY, Starr NC, et al. Are nonsteroidal anti-inflammatory drugs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty? A randomized, controlled study. Int Forum Allergy Rhinol. 2022;12:910–916.