Muruganandam Vignesh, Savery Nishanth, Sakthignanavel Arulmozhi
Department of Otorhinolayrngology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry, India.
Indian J Otolaryngol Head Neck Surg. 2025 Jan;77(1):265-270. doi: 10.1007/s12070-024-05166-w. Epub 2024 Nov 4.
Nasal packing following nasal procedures are commonly used to reduce post operative bleeding and pain. Removal of nasal pack may be associated with mucosal injury which may cause delayed recovery. Various aspects of post-operative pain management have been studied. Opioids such as fentanyl, morphine and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative pain. Fentanyl used topically results in a longer duration of action with a lower dosage and fewer adverse effects than IV therapy. To compare the efficacy of Fentanyl-soaked Nasal Packing on post operative pain in patients undergoing Nasal surgeries versus normal saline pack. A randomized control trial conducted among patients undergoing Nasal Surgery in the age group between 20 to 50 years at a tertiary care centre, Puducherry, India. Patients were randomly divided into two groups with 34 participants in each. Group A received Postoperative Nasal pack with 50mcg of Fentanyl and group B received Postoperative Nasal pack with Normal saline. Data were analysed using SPSS 21. The mean RSS score was 2.03 ± 0.83 and 1.38 ± 0.49 in group A and B respectively. The RSS score was significantly higher among group A than B. At all hours, mean Verbal pain intensity scale and numeric pain rating scale were significantly lower among Group A than B. At 1, 6,12 and 36 hours, Wong-Baker pain rating scale was significantly lower among Group A than B. There was no significant difference in hemodynamic parameters between the groups. The fentanyl group experienced much less postoperative pain without experiencing any significant adverse effects. We propose that applying topical fentanyl to nasal packs may be a feasible strategy to alleviate discomfort during the initial phases of recovery following nasal surgery.
鼻部手术后进行鼻腔填塞通常用于减少术后出血和疼痛。取出鼻腔填塞物可能会导致黏膜损伤，进而可能导致恢复延迟。人们已经对术后疼痛管理的各个方面进行了研究。芬太尼、吗啡等阿片类药物以及非甾体抗炎药（NSAIDs）常用于治疗术后疼痛。局部使用芬太尼比静脉注射疗法作用时间更长、剂量更低且不良反应更少。比较芬太尼浸润的鼻腔填塞物与生理盐水填塞物对接受鼻腔手术患者术后疼痛的疗效。在印度本地治里的一家三级护理中心，对年龄在20至50岁之间接受鼻腔手术的患者进行了一项随机对照试验。患者被随机分为两组，每组34名参与者。A组接受含50微克芬太尼的术后鼻腔填塞物，B组接受含生理盐水的术后鼻腔填塞物。使用SPSS 21对数据进行分析。A组和B组的平均静息痛评分分别为2.03±0.83和1.38±0.49。A组的静息痛评分显著高于B组。在所有时间点，A组的平均言语疼痛强度量表和数字疼痛评分量表均显著低于B组。在1、6、12和36小时，A组的面部表情疼痛评分量表显著低于B组。两组之间的血流动力学参数没有显著差异。芬太尼组术后疼痛明显减轻，且未出现任何显著的不良反应。我们认为，在鼻腔填塞物中应用局部芬太尼可能是减轻鼻腔手术后恢复初期不适的一种可行策略。
