Postoperative pain in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery

Abstract

Introduction: Postoperative pain management after endoscopic sinus surgery (ESS) va­ries widely, with no universally accepted standardized protocols. Due to concerns regarding opioid misuse, there is reluctance to prescribe these medications. Objectives: To evaluate postoperative pain in patients with chronic rhinosinusitis (CRS) undergoing ESS using a rescue-based analgesic regimen. Materials and Methods: A prospective cohort study in­cluding patients over 18 years of age with CRS who underwent ESS between January 2023 and January 2024 at Hospital del Salvador. Patients received scheduled acetaminophen, with ibuprofen as rescue medication, or tramadol in cases of nonsteroidal anti-inflam­matory drug (NSAID) allergy. Pain was assessed using a 100 mm visual analog scale (VAS) from the first to the seventh postoperative day (POD). As a secondary outcome, pain was analyzed according to different clinical variables. Results: Seventeen patients were inclu­ded. The median age was 53 years; 10 women and 7 men. Median pain scores for POD1 and POD2 were 50 mm and 45 mm on VAS, respectively, with progressive subsequent decrease. Eleven patients required rescue medication. Subgroup analysis revealed significant diffe­rences in pain among patients with cystic fibrosis (CF) on POD2 (p = 0.0424) and POD3 (p = 0.0433), and among those undergoing Draf III procedures on POD1 (p = 0.0388). Conclusions: Postoperative pain following ESS in CRS appears manageable with acetami­nophen and rescue ibuprofen from POD3 onwards. However, patients with CF and those undergoing Draf III experienced moderate pain, suggesting that low-potency opioids may be considered on selected PODs.