The Utility of Long-acting Local Anesthetic Agents in Reducing Post-operative Opioid Requirements Following Rhinoplasty
Status:
Recruiting
Trial end date:
2021-12-31
Target enrollment:
Participant gender:
Summary
On average, more than 130 Americans die every day from opioid overdose. Surgeons provide 37%
of all opioid prescriptions in the United states, second only behind pain management
physicians. A recent report found that patients who receive a 5-day supply of opioid
medication have a 10% chance of using opioids 12 months later. Additionally, studies have
shown that many opioid abusers are not the intended recipient, with over half diverting them
from friends and family.
Rhinoplasty is one of the most common procedures performed by facial plastic surgeons, with
over 215,000 performed in the United States in 2017. Patients undergoing nasal surgery have
been shown to be at significant risk for persistent and prolonged opioid use after filling an
opioid prescription in the perioperative period. Thus, the management of postoperative pain
without contributing to the opioid epidemic is a imperative.
The first three days following nasal surgery are generally associated with considerable pain,
with the highest levels occuring within the initial 24 hours. Published studies have
demonstrated the benefit of non-opioid medications following rhinoplasty, such as pregabalin
and celecoxib. There has also been growing recognition of the benefits of "pre-emptive
analgesia," such as the use of local anesthesia, which not only helps control pain, but in
turn decreases the anxiety caused by pain and can prevent patient turning to narcotics to
break the cycle. These studies have predominantly focused on the immediate postoperative
period, e.g. the first 24 hours.
Currently, many surgeons use lidocaine with 1% epinephrine as local anesthesia for
rhinoplasty due to its widespread availability, rapid time to onset, and safety profile.
Several studies have shown the benefit of Marcaine bupivacaine over lidocaine for pain
control and opioid consumption during the first 24 hours after surgery. This is not
surprising, as the half-life of lidocaine is approximately 90 minutes in a healthy
individual, compared to 160 minutes for Marcaine bupivacaine. However, there are no studies
to date that have evaluated the effect that long-acting local anesthesia has on
post-operative opioid consumption past the first 24 hours after surgery. Our study aims to
compare total postoperative opioid use for patients who received lidocaine as local
anesthesia at the time of surgery versus a mixture of lidocaine and Marcaine bupivacaine.
Phase:
Early Phase 1
Details
Lead Sponsor:
Our Lady of the Lake Hospital
Collaborator:
Louisiana State University Health Sciences Center in New Orleans