Discussion
postoperative pain, anxiety, Pain, pain, depression, chronic sinus symptoms
Preoperative education to simulate postoperative nasal packing and improve the patient’s tolerance to fentanyl requirement was not effective in immediate post-surgery. There were also no differences in requests for analgesics other than fentanyl (i.e., opioids other than fentanyl, acetaminophen, NSAID) between the groups.Our study was based on the recommendation that anesthesiologists need to inform patients preoperatively to breathe through their mouths after nasal surgery [Another possible reason for the contrasting results is the difference in education methodology. The education timing and duration may have affected the effect of education. In the study of Zhou et al. in colorectal surgery, education was carried out repeatedly over several days with illustration [A recent meta-analysis showed that psychological preparation may be helpful for postoperative pain, behavioral recovery, and negative affect, although with a low quality of evidence because of heterogeneity of analyzed surgery [The education targeted to change the patients’ insight into pain and analgesia request, and clinicians’ awareness for multimodal analgesia may be helpful. In Parsa et al.’s study, they focused on reinforcing the patients’ cognition on the role of endogenous beta-endorphin in analgesia after breast augmentation surgery, and how opioids can hinder its action and reduce mood of well-being [The strength of our study is that we tried to investigate preoperative non-pharmacologic, simulated training to affect postoperative patient care. Preoperative psychological preparation and simulated training is not harmful, and may potentially be helpful for postoperative outcome [This study has several limitations. First, this study was conducted at a single center with a Korean population, which may limit the generalizability to a broader population. Pain perception and discomfort are subjective experiences influenced by various factors, including culture, individual experiences, and personality traits. These differences encompass coping mechanisms towards pain, individual differences in pain tolerance, and diverse responses to the education intervention. Second, because the simulation and education were conducted on the evening before the surgery, patients might not have had enough time to fully conceptualize it. When conducting preoperative education, it would be beneficial to consider personalized education methods, such as the use of cartoons or explanatory texts, and allow enough time and repeated exposure to educational content, instead of intensive education immediately before surgery. Third, the preoperative level of anxiety was not evaluated in our patients, which could have affected the immediate postoperative need for opioids, because the prevalence of depression and anxiety is relatively high in patients with chronic sinus symptoms [In conclusion, our intensive preoperative mouth breathing training and education did not improve patient comfort or reduce opioid requirements. However, further studies with a modified explanation approach might be warranted.