Pain treatment and recovery after endoscopic sinus surgery.
OBJECTIVE
Early recovery and pain management after endoscopic sinus surgery (ESS) are largely unexplored regardless of the large number of ESSs performed by otorhinolaryngologists. In the present study, we evaluated whether scheduled administration of acetaminophen (paracetamol) for pain management after ESS would allow faster recovery to normal daily activities compared with acetaminophen administered on an as needed basis.


METHODS
Open, prospective, randomized, controlled clinical trial with two parallel groups.


METHODS
There were 78 patients who were undergoing ESS and were randomized into two groups. The "scheduled" group (n = 38) was instructed to take two acetaminophen 665 mg modified-release tablets three times a day during the first five postoperative days, whereas the "as needed" group (n = 40) was given instructions to use acetaminophen 665 mg tablets only on an as needed basis. Patients filled in a questionnaire at the follow-up visits on the 7th and 30th postoperative days. The main outcome measures were return to normal daily activities (primary endpoint) and pain during the first week after surgery and patients' satisfaction with pain management (secondary endpoints).


RESULTS
Patients returned to their normal daily activities in 8.8 (SD 4.8) days in the "scheduled" group versus in 10.3 (SD 7.0) days in the "as needed" group (mean difference 1.5; 95% CI of the difference -1.3 to 4.2; P = .29). In the "scheduled" group, the mean of worst pain was 3.4 (2.9) compared with 5.2 (3.0) in the "as needed" group on an 11-point scale (mean difference 1.7; 95% CI of the difference 0.4-5.2; P = .019). The patients in both groups were equally satisfied with pain management.


CONCLUSIONS
The present study suggests that patients recover in 9 to 10 days after ESS when provided with appropriate pain management. Our data indicate that by prescribing scheduled acetaminophen, postoperative pain after ESS can be controlled effectively without the need for opioid analgesics.
Kemppainen
Tatu P
TP
Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland. tatu.kemppainen@kuh.fi
Tuomilehto
Henri
H
Kokki
Hannu
H
Seppä
Juha
J
Nuutinen
Juhani
J
D000082:Acetaminophen / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000502:physiology*; D015523:Maxillary Sinusitis / Q000601:surgery*; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen