Kim Kwan-Sub, Yu Sung Chul, Han Jung-Woo, Shim Sung-Min, Kwak Soohyun, Kim Yong-Min, Kim Seong-Su
a Department of Anesthesiology and Pain Medicine, Dongkang Medical Center , Ulsan , South Korea.
b Department of Plastic Surgery, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea.
J Plast Surg Hand Surg. 2019 Jun;53(3):167-172. doi: 10.1080/2000656X.2019.1566738. Epub 2019 Feb 8.
Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial.
Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat.
Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p < .05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p < .05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p > .05).
Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery.
鼻骨骨折复位手术后通常会进行鼻腔填塞以控制出血。然而，患者在鼻腔填塞及取出后会遭受疼痛，需要进一步的镇痛治疗。本研究旨在通过一项前瞻性、随机、双盲对照试验，评估芬太尼浸润填塞作为一种控制鼻科手术后疼痛方法的效果。
本研究纳入了65例接受闭合性鼻骨骨折复位手术的患者。32例患者术后使用含50微克芬太尼的美洛赛（一种可生物降解的合成聚氨酯泡沫填塞物）进行治疗，另外33例患者使用盐水浸润的填塞物进行治疗。为分析芬太尼对鼻腔疼痛的相对控制效果，使用了数字评分量表、患者满意度和 Ramsay 镇静量表。对患者进行密切监测，记录相关心肺指标以及头痛或喉咙痛等不良症状的程度。
芬太尼组在术后的大部分时间段内数字评分量表得分显著更低，患者满意度更高（p < 0.05）。头痛和喉咙痛症状也显著减轻。与对照组相比，Ramsay 镇静量表评分有所改善（p < 0.05）。两个实验组之间的心肺相关指标未观察到显著差异（p > 0.05）。
芬太尼浸润填塞显著减轻了术后疼痛，且未观察到不良反应。我们的结果表明，在鼻腔填塞中局部应用芬太尼是闭合性鼻骨骨折复位手术后控制术后疼痛的有效方法。
