Topical intranasal analgesia with EMLA for closed rhinoplasty

Abstract

Background: Rhinoplasty is a traumatic procedure associated with postoperative pain. The purpose of this study is to determine the effect of topically administered intranasal EMLA 5% cream (lidocaine 25 mg/ prilocaine 25 mg) on the pain experienced in the postoperative period by patients who underwent closed rhinoplasty. Materials and methods: The study was conducted between October 2014 and May 2016 and included 66 patients divided in two groups, all of whom underwent closed rhinoplasty. In the first group (n = 33) when packaging and placing the nasal splint, each intranasal tampon (with Gelaspon) was applied with 2 ml EMLA 5% cream, and in the control group (n = 33) 2 ml Deflamol ointment was applied on each tampon. All patients were operated under general anesthesia after introduction with intravenous Propofol and maintenance of the anesthesia with Sevoflurane and opioid analgesic. After placing the patient under general anesthesia, the otorhinolaryngologist carries on with local infiltration anesthesia with a solution of lidocaine 0.5% and adrenaline 1: 100,000 4-6 ml. All patients received oral antibiotic treatment (with Klacid or Zinnat) for the period of the packaging. No corticosteroids were included in the therapeutic scheme. Post-operative pain was assessed on a visual analog scale on the 1, 3, 6, 12, 24, 48 hour in the patients of both groups. Results: The statistical analysis shows that there is a significant difference in reported results for the treatment of post-operative pain on the 1, 6 and 12 hour period in both groups studied. Four of the patients (12%) in the EMLA group had results from the VAS > 40 mm and required administration of a non-opioid analgesic in the first 24 hours, whilst in the control group this number of patients was 13 (39%). Conclusion: Intranasal application EMLA 5% cream in the packaging for reducing postoperative pain in patients who underwent closed rhinoplasty proves to be a simple and effective technique, in which we have not found adverse side effects in the study group patients despite this off label usage.