Intranasal Dexmedetomidine on Stress Hormones, Inflammatory Markers, and Postoperative Analgesia after Functional Endoscopic Sinus Surgery

Abstract

Background. A strong ongoing intraoperative stress response can cause serious adverse reactions and affect the postoperative outcome. This study evaluated the effect of intranasally administered dexmedetomidine (DEX) in combination with local anesthesia (LA) on the relief of stress and the inflammatory response during functional endoscopic sinus surgery (FESS). Methods. Sixty patients undergoing FESS were randomly allocated to receive either intranasal DEX (DEX group) or intranasal saline (Placebo group) 1 h before surgery. Stress hormones, inflammatory markers, postoperative pain relief, hemodynamic variables, blood loss, surgical field quality, body movements, and satisfaction were assessed. Results. Plasma epinephrine, norepinephrine, and blood glucose levels were significantly lower in DEX group as were the plasma IL-6 and TNF-α levels (P < 0.05). The weighted areas under the curve (AUCw) of the VAS scores were also significantly lower in DEX group at 2–12 h after surgery (P < 0.001). Furthermore, hemodynamic variables, blood loss, body movements, discomfort with hemostatic stuffing, surgical field quality, and satisfaction scores of patients and surgeons were significantly better (P < 0.05) in DEX group. Conclusions. Patients receiving intranasal DEX with LA for FESS exhibited less perioperative stress and inflammatory response as well as better postoperative comfort with hemostatic stuffing and analgesia.

Efficacy of dexmedetomidine on perioperative morbidity during nasal surgery: A meta‐analysis

“…Surgical trauma, a main cause of postoperative pain, leads to peripheral sensitization via the release of inflammatory mediators from immune cells and nonneuronal cells in the periphery. Additionally, a peripheral nociceptive stimulus from surgical trauma directly can cause central sensitization . Dexmedetomidine administration was reported to decrease the level of inflammatory cytokines such as IL‐6 and TNF‐α after nasal surgery group in a previous study.…”

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

“…No other systematic review or meta‐analysis was found pertaining to perioperative and postoperative analgesic use for endoscopic sinus surgeries. Thirty‐two studies met the inclusion criteria for this project: all of the included studies were randomized, controlled trials (RCTs). Using the Cochrane Bias tool, we judged 4 studies to be at high risk, 21 to be at moderate risk, 6 to be at low risk, and 1 to be at unclear risk of bias.…”

“…Although our review has included several articles demonstrating the viability of outpatient non‐opioid analgesia, a significant portion of analyses focused on immediate postoperative analgesia. Immediate postoperative pain harbors an outsize impact on psychological factors and physiologic stress; when associated anxiety is controlled, this can potentially decrease the need for subsequent opioids. Furthermore, even for non‐opioid analgesics demonstrated to have efficacy in the immediate postoperative setting, these data reinforce which opioid‐avoiding regimens can be adopted, that is, that opioid alternatives are sufficient.…”

“…Misuse and diversion of outpatient opioids have played a leading role in the opioid epidemic, as prescriptions have quadrupled over a 15‐year period, leading to thousands of prescription drug–related overdose deaths in 2015 . Aggressive postoperative analgesia potentially decreases inflammatory cytokines released as a result of pain, leading to diminished subsequent analgesic requirements . Furthermore, improvement of immediate postoperative pain harbors a powerful potential for reduction of anxiety and any associated “carryover” effects .…”

Prescription patterns and opioid usage in sinonasal surgery

“…[6][7][8] To limit the surgeon's inadvertent effects in the opioid crisis, conservative postoperative analgesia after ambulatory surgery has been advocated as an area of improvement; however, aggressive immediate postoperative analgesia is thought to reduce subsequent analgesic requirements, alleviate anxiety, and improve patient satisfaction. 9,10 Thus, continued evaluation of prescription patterns as well as exact opioid usage for specific procedures and common surgical combinations is necessary to ensure effective pain management, reduce opioid diversion, and potentially limit opioid dependence. 8 Sinonasal surgical procedures are among the most common operations performed in otolaryngology, with over 260,000 septoplasties and 250,000 of these performed annually.…”