الفهرس 
Septorhinoplasty: Pain ManagementOnly 14 pages are availabe for public view
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Abstract
Septorhinoplasty is a common surgery that patients seek for functional or aesthetic purposes. Pain control after septorhinoplasty is a big concern for patient satisfaction, especially for aesthetic benefits.
Before 2009, intravenous ketorolac was the only intravenous FDA-approved NSAID for the treatment of postoperative pain. Despite the effective analgesia provided by intravenous ketorolac, it is associated with many adverse effects, such as heartburn, dyspepsia, and increased blood loss during and after surgeries. In 2009, the FDA approved intravenous ibuprofen as a monotherapy for mild to moderate pain and as an adjunct to opioids for moderate to severe pain.
The current study aimed to compare the efficacy of IV ibuprofen and IV ketorolac for relieving postoperative pain in patients after septorhinoplasty. The secondary aims were to assess intraoperative analgesia and hemodynamic parameters, the need for postoperative rescue analgesia, and the incidence of side effects.
Forty adult patients of either sex, belonging to ASA grades I-II, aged between 18-60 years old, undergoing elective septorhinoplasty under general anesthesia, were included in the study during the period from June 2022 till June 2023 at Menoufia University Hospital.
Eligible participants were randomly assigned in two equal groups: group I was administered 800 mg of ibuprofen, followed by three total scheduled doses of IV ibuprofen infusion every six hours for 24 hours. group K was administered 30 mg of, followed by three total scheduled doses of IV ketorolac infusion every six hours for 24
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hours. Rescue analgesia was administered at the request of the patients when visual analog scale (VAS) is ≥4 in both groups.
Results show that the use of ibuprofen, compared to ketorolac, significantly lowered pain scores during 24 hours postoperatively. We also found that there was a significant reduction in opioid consumption that was used as rescue analgesia with ibuprofen group. Both groups had comparable intraoperative hemodynamic parameters and anesthetic requirements.
Regarding gastrointestinal complications, we here report comparable postoperative heartburn incidence in IV ibuprofen and ketorolac treated patients. None of the participants in either group reported GI bleeding. However, we reported a higher incidence of postoperative nausea and vomiting in ketorolac treated patients. IV ketorolac was associated with significantly more intraoperative blood loss, postoperative hemoglobin drop, and more prolonged bleeding time compared to ibuprofen.
Under the conditions of this study, IV Ibuprofen seems to be a better choice than IV Ketorolac as a component of multimodal analgesia regimen in patients undergoing septorhinoplasty considering its efficacy and safety profile.