Postoperative analgesia in rhino surgery: An effective regimen with tramadol plus acetaminophen

Aim. The aim of this study was to assess the level of pain in patients undergoing to septo- and septorhinoplasty in order to develop an adequate protocol with tramadol plus acetaminophen. Methods. A group of 295 patients underwent septoplasty (group 1) and septorhinoplasty (group 2). In order to evaluate pain a visual analogical scale was used (VAS) 0, 4,12, 20 h postoperatively. The analgesic protocol began 10 minutes before the end of surgical procedure, and provided the infusion of acetaminophen (1 g) plus tramadol (1.5 mg/kg). Thirty minutes after surgery patients were treated with tramadol (200 mg) plus metoclopramide (10 mg in 500 mL of electrolytic solution) at 63 mL/h in continuous intravenous infusion. Paracetamol 1 g i.v. at 400 mL/h was administered after 8 hours, at the end of the first drug infusion. If VAS was equal or higher than 3 a rescue dose tramadol 50 mg plus metoclopramide 10 mg in 100 mL of NaCl 0.9% at 400 mL/h was administered. At day one intravenous therapy was stopped and replaced with oral administration of acetaminophen, 500 mg twice a day. Results. A good control of postoperative pain was obtained in 96.8% (group 1) and 81.4% (group 2) of the patients 4 hours after surgery. No significant differences were found with regard to pain scores and side effects. Conclusion. A protocol with tramadol and acetaminophen is extremely efficacious in the treatment of postoperative pain in the septo- and septorhinoplasty patients, with low rate of side effects.