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Introduction: Within facial plastic and reconstructive surgery (FPRS), prescription practices have trended toward prescribing larger amounts of perioperative opioids. However, there is limited literature regarding the postoperative pain experience and opioid consumption for FPRS. The purpose of our study was to investigate opioid prescription and consumption following procedures of the nose, with the aim of developing evidence-based guidelines for postoperative pain management.

Methods: In this prospective single center study, morphine milligram equivalents (MME) consumption and pain scores were collected in 72 patients who underwent nasal surgery. Patient demographics, MME use, and pain scores were examined. MME use was compared to patient demographics, surgical procedure type, and postoperative pain scores.

Results: In total, 3427 MME were prescribed: 2082 MME (60.8%) were used, leaving 1345 MME (39.2%). Patients were prescribed a total average of 47.6 ± 23.6 MME. Four (5.6%) patients required a second prescription. Average pain peaked on postoperative day 0 (POD0) and trended downwards. Visual analog scale (VAS) score dropped from 5.5 ± 2.8 on POD0 to 1.7 ± 1.9 at POD office visit. Mean POD follow-up visit was 7.0. Obesity, smoking (current and former), and history of opioid use were negative predictors of opioid consumption in postoperative patients (P<0.05).

Discussion: A significant portion of opioid prescriptions are not consumed by patients after nasal surgery, and several factors may explain why some patients use fewer opioids. Assessing opioid consumption for nasal procedures will guide prescribing practices. Our results indicate that prescription practices can likely be down titrated in select patients.