Effects of Bupivacaine Versus Bupivacaine Plus Dexamethasone-Soaked Nasal Packing After Endoscopic Nasal Surgery

Abstract

Background: The aim of this randomized prospective study was to investigate the postoperative analgesic effectiveness of bupivacaine versus bupivacaine plus dexamethasone-soaked nasal packing in patients scheduled for endoscopic nasal surgery. Methods: Sixty American Society of Anesthesiologists groups I and II patients aged 18 to 65 years and scheduled for endoscopic nasal surgery were assigned into 2 groups. Group B received 8 mL 0.5% bupivacaine and 2 mL saline, and group BD received 8 mL 0.5% bupivacaine and 8 mg (2 mL) dexamethasone-soaked nasal packing. In the postoperative period, 1000 mg paracetamol was administered and repeated every 6 hours. Postoperative pain scores, additional analgesia requirements and nausea-vomiting were recorded. Results: Postoperative pain scores were significantly lower in group BD than in group B at 1, 2, 4, 8, and 12 hours, and during tampon removal (P < 0.05), but there was no difference between the groups’ 24-hour visual analog scale scores ( P = 0.115). Postoperative additional analgesia use was statistically significantly higher in group B than in group BD (25/30 versus 13/30 respectively, P = 0.001). Postoperative nausea and vomiting was statistically higher in group B than in group BD (11/30 versus 4/30 respectively, P = 0.037). Conclusion: The addition of dexamethasone to bupivacaine via soaked nasal packing in endoscopic nasal surgery reduced postoperative pain scores, additional analgesia requirements, and PONV. The authors recommended a combination of bupivacaine plus dexamethasone-soaked nasal packing after endoscopic nasal surgery.

Evaluation of Analgesia Using Perineural Dexamethasone Compound in Interscalene Brachial Plexus Block After Shoulder Surgery

“…The results showed that the intensity of pain in the experimental group (dexamethasone) was lower than in the control group at 12 and 24 hours after surgery, indicating that dexamethasone was able to significantly reduce pain in patients. These findings are consistent with the results of studies by Pehora et al ( 7 ), Yayik et al ( 10 ), Badran et al ( 11 ), and Kim et al ( 12 ). For instance, Badran et al demonstrated that adding 8 mg of perineural dexamethasone to 30 cc of bupivacaine 0.5% improved postoperative pain relief in shoulder surgery without apparent side effects and prolonged the duration of the block ( 11 ).…”

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…The addition of lidocaine to Nasopore ® , intra‐operatively and 8 hours post‐surgery appeared to be significantly reduced immediate post‐operative pain for up to 16 hours after surgery, 1887 while gloved Merocel ® packs were found to cause less discomfort on removal than standard Merocel ® packs 2178 . In an RCT Yayik et al showed that adding bupivacaine and dexamethasone to the nasal pack decreased pain and analgesic requirements in the first 24 hours after surgery 2199 . In another RCT Garzaro et al showed that adding 5 mL of lidocaine to a PVA sponge did not result in less pain then a saline soaked sponge in a gloved finger 2200 .…”

Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

“…4 Many pharmacological or non-pharmacological methods have been attempted for pain management after septorhinoplasties such as nonsteroidal anti-inflammatory analgesics, intravenous (IV) lidocaine infusion, a-2 receptor agonists, gabapentinoids, and intraoperative local anesthetic infiltration. [5][6][7] In the last 2 decades, many studies have been conducted on the effects of ketamine on postoperative pain, chronic pain, depression, and postop delirium treatment. [8][9][10][11] Ketamine is a phencyclidine derivative synthesized in 1962.…”

“…4 Many pharmacological or non-pharmacological methods have been attempted for pain management after septorhinoplasties such as nonsteroidal anti-inflammatory analgesics, intravenous (IV) lidocaine infusion, α-2 receptor agonists, gabapentinoids, and intraoperative local anesthetic infiltration. 5 -7…”