The effect of simultaneous rhinoplasty and septoplasty on the development of postoperative pain syndrome

Introduction. One of the most difficult goals in facial reconstructive surgery is to eliminate defects in the external nose. Difficulties may arise with simultaneous septo- and rhinopalasty, as there is a need to restore and preserve the structures of the nasal cavity. To date, there are not many studies that would be aimed at assessing the pain syndrome after surgery on the structures of the nose, which was the impetus for studying this problem. The purpose of the study. The purpose of this study was to study the severity of acute pain syndrome after septoplasty, rhinoplasty and rhinoseptoplasty. Materials and methods. A total of 98 patients, 19 men and 79 women, aged from 18 to 45 years, were examined and operated on. The open rhinoplasty group (group 1) included 6 men and 27 women, the open rhinoseptoplasty group (group 2) - 7 men and 26 women, and the septoplasty group (group 3) included 6 men and 26 women. To ensure premedication, all patients were prescribed 2 ml of 0.4% dexamethasone solution, 4 ml of 0.2% ondacetron solution. Preoxygenation of 100% O2 5-6 l/min was carried out with the help of an anesthetic mask. Induction of anesthesia was carried out with 20 ml (200 mg) of 1% propofol emulsion. To achieve myoplegia, a solution of ridelate C (50 mg) was administered. For anesthesia purposes, 2 ml of 0.005% fentanyl solution (0.1 mg) was administered intravenously. Infiltration anesthesia during rhinoplasty was carried out using a 2% solution. Local anesthesia was performed by intramuscular administration of a 50 mg ketoprofen solution before surgery, 24 and 48 hours after manipulation, as well as for 3 days after it, taking into account the severity of the pain syndrome. After performing rhinoplasty, septoplasty and rhinoseptoplasty, the severity of the pain syndrome was assessed using a visual analog scale (VAS), a digital rating scale (DRS) and facial pain scale (FPS 3, 6, 24, 48 hours after the end of surgery. Results. According to the VAS pain syndrome assessment, the pain intensity in group 1 was maximal one hour after rhinoplasty and subsequently had negative dynamics: on the 3rd, 6th (p<0.001), 24th (p<0.05) and 48 th (p<0.001) hours after surgery. In groups 2 and 3, the highest pain intensity was recorded at the 3rd hour after surgery (p<0.001), compared with the hour after surgery. According to the DRS, the intensity of pain 3 hours after rhinoplasty in group 1 decreased, compared with his assessment 1 hour after surgery, and continued to decrease on the 3rd, 6th (p<0.001), 24th (p<0.01) and 48th hours (p<0.001). In group 2, 3 hours after surgical manipulation, the intensity of the pain syndrome increased significantly compared to the previous period of its assessment (p<0.05), which was also found in the group of patients after rhinoseptoplasty (p<0.05) at the same time. Assessing the severity of the pain syndrome according to FPS, in group 1, the pain syndrome was insignificant and did not cross the threshold. In patients of groups 2 and 3, compared with the 1st hour after the interventions, pain syndrome significantly increased after 3 hours (p<0.001), but subsequently decreased. Conclusion. Based on the analysis of acute postoperative pain syndrome, this study confirms that septoplasty is a more traumatic intervention compared to rhinoplasty, and surgical operations in the area of the external nose and on the nasal septum in the early postoperative period entail excalation of stress reactions, relative to rhinoplasty and septoplasty.