Different anesthetic agents-soaked sinus packings on pain management after functional endoscopic sinus surgery: which is the most effective?

Abstract

In the present study, we investigated the efficacy of local anesthetics soaked non-absorbable sinus packs on pain management after functional endoscopic surgery (FESS). One hundred and fifty patients with the diagnosis of bilateral chronic sinusitis with or without nasal polyps who underwent FESS were included into the study. Their pre-operative Lund-Mackay computerized tomography (CT) Scores were similar. We applied anesthetic agents of 2% lidocaine HCl, 0.25% Bupivacaine HCl, 0.2% Ropivacaine, 2% Prilocaine and 0.9% NaCl (Saline) in groups 1-5 onto the sinus packs after FESS. At postoperative period, acetaminophen (250mg/5ml) was used in 10-15mg/kg per dose (4 times a day). Bleeding grade, operation duration, postoperative number of gauze/24h, additional painkiller need, pain values at 1, 2, 4, 8, 12 and 24h were noted. Lund-Kennedy endoscopic scores were also evaluated at 1st, 2nd and 4th weeks postoperatively. In saline group, 93.3% of the patients needed additional painkiller. Whereas, in Bupivacaine group, additional painkiller use (20.0%) is less than the other groups. In Bupivacaine group, number of gauze/24h use was lower than lidocaine, ropivacaine and prilocaine groups. In our study, except 1st and 24th hours, pain values of groups can be written in ascending order (from less to higher) as Bupivacaine, Lidocaine, Prilocaine, Ropivacaine and Saline. In the first hour, pain values of groups can be written in ascending order (from less to higher) as Lidocaine, Prilocaine, Bupivacaine, Ropivacaine and Saline. In the 2nd week, in the Bupivacaine and Lidocaine Groups separately, postoperative Lund-Kennedy scores were lower than the Prilocaine and Saline Groups. In the 1st month, Lidocaine Group's Lund-Kennedy scores were significantly lower than the Saline Group. Synechia values were not different between groups. Bupivacaine help the lower pain values and less additional painkiller need after FESS. Therefore, we recommend to use Bupivacaine soaked sinus packs after FESS for achieve less pain values and to improve patient satisfaction.