Dexmedetomidine-soaked nasal packing can reduce pain and improve sleep quality after nasal endoscopic surgery: a double-blind, randomized, controlled clinical trial

• Published in: Sleep & breathing 2021-12, Vol.25 (4), p.2045-2052
• Main Authors: Wang, Yuting, Shuai, Yu, Qiu, Fudan, He, Jiamei, Zhuang, Shaohui
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adult; Analgesia; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - pharmacology; Clinical trials; Dentistry; Dexmedetomidine - administration & dosage; Dexmedetomidine - pharmacology; Dosage; Double-Blind Method; Double-blind studies; Endoscopy; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Nasal Surgical Procedures - adverse effects; Natural Orifice Endoscopic Surgery - adverse effects; Neurology; Otorhinolaryngology; Outcome Assessment, Health Care; Packing; Pain; Pain Measurement; Pain perception; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patients; Pediatrics; Pneumology/Respiratory System; Sleep; Sleep Breathing Physiology and Disorders • Original Article; Sleep Quality; Surgery
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-021-02342-y

Study objective Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery. Method Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg −1 (D1), 2μg kg −1 (D2), 4 μg kg −1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS) recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded. Results Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events. Conclusions Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg −1 may be optimal. Trial registration www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019