Enhanced Post-Operative Analgesia in Nasal Surgery: A Randomised Controlled Trial of Fentanyl-Augmented Lignocaine versus Plain Lignocaine Nasal Packing.

Abstract

Introduction:

Nasal packing is commonly used after nasal surgeries to control bleeding, reduce dead space, support tissue healing, and prevent synechiae formation. However, it is often associated with significant pain and discomfort, particularly during insertion and removal. Pain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience linked to actual or potential tissue damage. Effective postoperative pain management is therefore essential, as it enhances patient comfort, reduces complications, and contributes to improved surgical outcomes and shorter hospital stays.

      Objectives:

The primary aim was to compare the efficacy of fentanyl-ligocaine nasal packing versus plain        ligocaine packing in reducing acute postoperative pain following nasal surgeries under general anesthesia.

Methods:

This randomized clinical trial enrolled 60 patients undergoing nasal surgery under general anesthesia, who were randomly allocated into two groups (n = 30 each) using a closed-envelope technique. Group A received nasal packing impregnated with 9 mL of 2% lignocaine and 1 mL fentanyl (50 μg), whereas Group B received 9 mL of 2% lignocaine with 1 mL normal saline. Postoperative pain was assessed using the 11-point Numeric Rating Scale (NRS) and the Visual Analogue Scale (VAS). Hemodynamic parameters, including pulse rate and blood pressure, were recorded at 0, 6, 12, 18, and 24 hours postoperatively.

Results:

The Fentanyl-Lignocaine group showed significantly lower pain scores on both NRS and VAS at all time points (P < 0.05, independent t-test/Mann-Whitney U as appropriate). No significant hemodynamic changes or adverse events occurred in either group.

Conclusions:

 Fentanyl-lignocaine-augmented nasal packing provides safe, superior postoperative analgesia versus lignocaine alone after nasal surgery (NRS reductions: 2.1-3.4 points; P<0.05), enhancing recovery and patient satisfaction without adverse effects. Broader adoption is recommended pending multicenter validation.