Discussion
obesity, postoperative pain, nausea, sleep disorders, sleep disorder, Postoperative pain, postoperative nausea and vomiting, vomiting, pain, nasal obstruction
OBESITY, INFILTRATION, ADVERSE EVENTS, ADVERSE EFFECTS, INFILTRATING, RESPIRATORY DEPRESSION, DISEASES
This study found that both 0.03 mg/kg and 0.04 mg/kg butorphanol-soaked nasal packing could decrease VAS score and increase SSQV without increasing recovery time or incidences of adverse events, which means that 0.03 mg/kg and 0.04 mg/kg butorphanol infiltrating nasal packing could effectively and safely reduce pain and improve sleep quality after endoscopic nasal surgery.Current research on postoperative analgesia after endoscopic nasal surgery focuses on medications, such as opioids, nonsteroid anti-inflammatory drugs and αWe also explored the possible appropriate concentration of butorphanol for nasal packing. In this clinical trial, a large number of patients experienced moderate-to-severe pain in the first 24 h after surgery, which is consistent with the results of other studies on postoperative pain after nasal surgery.Postoperative pain can cause disturbance of circadian rhythm. Bilateral nasal obstruction with tight packing and altered breathing with mouth opening result in poor sleep quality, which could further lower the threshold of pain. Postoperative pain and sleep disorder are reciprocal. In this study, we also investigated the effect of butorphanol nasal packing on sleep quality. The result showed that All patients experienced sleep disorders after surgery. Sleep quality on the first night was worse than that on the second night. Butorphanol groups had higher scores of both SSQV1 and SSQV2. Additionally, the number of patients with poor sleep quality (SSQV < 30) in the control group was higher than that in butorphanol groups (group N, 75%; group B1, 35%; group B2, 30%). The number of patients with good sleep quality (SSQV > 90) was higher in butorphanol groups than in the control group (group N, 10%; group B1, 22%; group B2, 44%). However, there was no significant difference between group B1 and B2. Therefore, with respect to improvements in sleep quality, 0.03 mg/kg butorphanol for nasal packing is effective.This study also showed that the incidence of postoperative nausea and vomiting was lower in group B1 (0.03 mg/kg) than group N. This result was similar to Yang’s research,Butorphanol-soaked nasal packing may also be an alternative for postoperative pain management in patients with obesity. First, butorphanol is a partial agonist of μ receptors and agonist of κ receptors without dose-related respiratory depression,This study proves that butorphanol-soaked nasal packing can effectively reduce pain and improve sleep quality after bilateral endoscopic nasal surgery without increasing adverse effects, which is a noninvasive and practical method of pain relief and sleep improvement for these patients. Comparison of two concentrations of butorphanol infiltrating nasal packing provides a possibly appropriate concentration of 0.03 mg/kg for clinical use. This double-blind, randomized controlled study was performed according to strict scientific protocols with reliable results and conclusions, which could be applied in clinical practice and bring actual benefits to patients.However, this study has some limitations. First, we found that a low concentration (0.03 mg/kg) of butorphanol reduced pain and improved sleep quality after endoscopic nasal surgery, with less nausea and vomiting compared with high concentration (0.04 mg/kg). But whether even lower concentration can provide equally effective postoperative analgesia requires further investigation. Second, the study included only young adults with relatively good health conditions (ASA grade I or II). Whether children, elderly patients or patients with severe underlying diseases who undergo endoscopic nasal surgery would benefit from this nasal packing remains unclear, which is what we will continue to explore in the future. Last but not least, Polyvinyl Alcohol (PVA) sponges were used for nasal packing. Further research could focus on other materials like Nasopore, vaseline gauze or polyurethane foam as infiltration carriers for postoperative pain control.