Anesthesia Modalities and Nasal Packing in Rhinoplasty: A Systematic Review of Complications, Postoperative Management, and Safety Guidelines

Abstract

Background: Rhinoplasty is one of the most commonly performed facial plastic surgeries worldwide. Despite its frequency, there is significant heterogeneity in perioperative management, particularly regarding the choice of anesthesia-local, local with sedation, or general-and the postoperative use of nasal packing. A clear, evidence-based consensus on safety and outcomes is lacking.

Objective: To systematically review the literature comparing anesthesia techniques used in rhinoplasty and their associated complication rates, and to assess the indications, benefits, risks, and duration of nasal packing postoperatively. The aim is to identify whether current evidence supports standardized safety protocols or guidelines.

Methods: A systematic search of PubMed and Scopus databases was conducted for studies published from January 2000 to May 2025. Inclusion criteria were clinical studies reporting outcomes of rhinoplasty under local, sedation, or general anesthesia, and studies comparing the use vs. nonuse of nasal packing post-surgery. Outcomes evaluated included intraoperative and postoperative complications, patient-reported discomfort, and mean duration of nasal pack placement.

Results: Forty-three studies were included. General anesthesia remains the most frequently used method (72%), with local anesthesia with sedation favored in selected secondary or minor procedures. Complication rates were not significantly different across anesthesia modalities, although general anesthesia had a slightly higher incidence of nausea and vomiting (12%) compared to sedation (7%) and local (4%). Regarding nasal packing, the literature shows a progressive trend toward minimal or no packing, citing lower patient discomfort, quicker recovery, and no increase in postoperative bleeding. The average duration of packing ranged from 24 to 72 hours.

Conclusions: Current literature supports the safe use of all anesthesia modalities in rhinoplasty when appropriately selected. Nasal packing appears increasingly avoidable in routine cases, without compromising safety. However, a lack of unified guidelines persists. The development of evidence-based perioperative protocols could standardize care and reduce variability in clinical practice. It should also be underlined that certain packing materials, such as carboxymethylcellulose-based absorbable sponges or silicone splints, can in fact reduce the risk of synechiae formation by maintaining separation of mucosal surfaces during healing. Thus, the blanket statement that packing is a source of synechiae must be nuanced: The material, duration, and indication are critical determinants.

Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Anesthesia; Cosmetic surgery; Plastic surgery; Rhinoplasty.