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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Opioids | Research

Effect of preoperative patient education and simulated mouth breathing training on opioid requirements in the post-anesthesia care unit after nasal surgery: a randomized controlled study

Authors: Yu Jeong Bang, Sojin Kim, Jin Kyoung Kim, Hara Kim, Seungmo Kim, Chi Song Chung, Seung Yeon Yoo, Heejoon Jeong, Boram Park, Sang Hyun Lee

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

Background

A simulated education, prior to surgery about postoperative nasal stuffiness and ease of breathing through the mouth may help patients tolerate discomfort after nasal surgery. This study aimed to investigate the effect of preoperative simulated education on immediate postoperative opioid requirements in patients undergoing elective nasal surgery.

Methods

This randomized controlled trial of 110 patients undergoing nasal surgery randomly allocated patients into either a control (group C) or an education group (group E). One day before surgery, patients in group E were intensively trained to breathe through the mouth by using a nasal clip, with informative explanations about inevitable nasal obstruction and discomfort following surgery. Patients in group C were provided with routine preoperative information. Total intravenous anesthesia (TIVA) with propofol and remifentanil was used for anesthesia. No further opioid was used for analgesia intraoperatively. The primary outcome was index opioid (fentanyl) requirements at the post-anesthesia recovery unit (PACU). Secondary outcomes were emergence agitation, pain scores at the PACU, and postoperative recovery using the Quality of Recovery-15 (QoR15-K).

Results

The rate of opioid use in the PACU was 51.0% in the group E and 39.6% in the group C (p = 0.242). Additional request for analgesics other than index opioid was not different between the groups. Emergence agitation, postoperative pain severity, and QoR15-K scores were comparable between the groups.

Conclusion

Preoperative education with simulated mouth breathing in patients undergoing nasal surgery did not reduce opioid requirements.

Trial registration

KCT0006264; 16/09/2021; Clinical Research Information Services (https://​cris.​nih.​go.​kr).
Appendix
Available only for authorised users
Literature
1.
Service KNHI. Main Surgery Statstical Yearbook of 2020.
2.
Davis GE, Yueh B, Walker E, Katon W, Koepsell TD, Weymuller EA. Psychiatric distress amplifies symptoms after Surgery for chronic rhinosinusitis. Otolaryngology–head and neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2005;132(2):189–96.CrossRefPubMed
3.
Maniaci A, Merlino F, Cocuzza S, Iannella G, Vicini C, Cammaroto G, Lechien JR, Calvo-Henriquez C, La Mantia I. Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2021;278(6):1743–53.CrossRefPubMedPubMedCentral
4.
Gropper MA, Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Leslie K. Miller’s anesthesia, 2-volume set E-book. Elsevier Health Sciences; 2019.
5.
Lee JT, Levine CG, Overdevest JB, Higgins TS, Manes RP, Myhill JA, Soler ZM. American Rhinologic Society expert practice statement: postoperative pain management and opioid use after sinonasal Surgery. Int Forum Allergy Rhinol. 2021;11(9):1296–307.CrossRefPubMed
6.
Raikundalia MD, Cheng TZ, Truong T, Kuchibhatla M, Ryu J, Hachem RA, Jang DW. Factors associated with opioid use after endoscopic sinus Surgery. Laryngoscope. 2019;129(8):1751–5.CrossRefPubMed
7.
Chung F, Ritchie E, Su J. Postoperative pain in ambulatory Surgery. Anesth Analg. 1997;85(4):808–16.CrossRefPubMed
8.
Olausson A, Svensson CJ, Andréll P, Jildenstål P, Thörn SE, Wolf A. Total opioid-free general anaesthesia can improve postoperative outcomes after Surgery, without evidence of adverse effects on patient safety and pain management: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2022;66(2):170–85.CrossRefPubMed
9.
Zhou L, Zhou L, Tian L, Zhu D, Chen Z, Zheng C, Zhou T, Zeng X, Jiang X, Jiang C, et al. Preoperative education with image illustrations enhances the effect of tetracaine mucilage in alleviating postoperative catheter-related bladder discomfort: a prospective, randomized, controlled study. BMC Anesthesiol. 2018;18(1):204.CrossRefPubMedPubMedCentral
10.
Parsa FD, Pavlosky KK, Harbison G, Yim N, Cheng J, Marison SR Jr., Parsa AA. Effect of Preoperative Patient Education on Opioid Consumption and Well-being in breast augmentation. Plast Reconstr Surg. 2020;145(2):316e–23.CrossRefPubMed
11.
Kasem A, Abdelkader A. Preoperative external nasal compression: does it decrease emergence agitation after nasal Surgery? Ain-Shams J Anaesthesiol. 2016;9:593.CrossRef
12.
Xará D, Silva A, Mendonça J, Abelha F. Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit. J Clin Anesth. 2013;25(6):439–46.CrossRefPubMed
13.
Hesse S, Kreuzer M, Hight D, Gaskell A, Devari P, Singh D, Taylor NB, Whalin MK, Lee S, Sleigh JW, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative Complications. Br J Anaesth. 2019;122(5):622–34.CrossRefPubMed
14.
Kim JH, Ham SY, Kim DH, Chang CH, Lee JS. Efficacy of single-dose dexmedetomidine combined with low-dose remifentanil infusion for Cough suppression compared to high-dose remifentanil infusion: a Randomized, Controlled, Non-inferiority Trial. Int J Med Sci. 2019;16(3):376–83.CrossRefPubMedPubMedCentral
15.
Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118(6):1332–40.CrossRefPubMed
16.
Yoon S, Joo H, Oh YM, Lee J, Bahk JH, Lee HJ. Validation and clinical utility of the Korean version of the quality of Recovery-15 with enhanced recovery after Surgery: a prospective observational cohort study. Br J Anaesth. 2020;125(4):614–21.CrossRefPubMed
17.
Rhee JS, Sullivan CD, Frank DO, Kimbell JS, Garcia GJ. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plastic Surgery. 2014;16(3):219–25. quiz 232.CrossRefPubMedPubMedCentral
18.
Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic review and Meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngology–head and neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2017;156(5):809–15.CrossRefPubMed
19.
Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngology–head and neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2004;130(2):157–63.CrossRefPubMed
20.
Gropper MA, Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Leslie K. Miller’s Anesthesia. 9th ed. Philadelphia, PA: Elsevier Health Sciences; 2019.
21.
Kwan SY, Lancaster E, Dixit A, Inglis-Arkell C, Manuel S, Suh I, Shen WT, Seib CD. Reducing opioid use in endocrine Surgery through patient education and provider prescribing patterns. J Surg Res. 2020;256:303–10.CrossRefPubMedPubMedCentral
22.
Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LM, Unsworth M, Osmer C, Johnston M. Psychological preparation and postoperative outcomes for adults undergoing Surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;2016(5):Cd008646.PubMedPubMedCentral
23.
Maniaci A, Lechien JR, La Mantia I, Calvo-Henriquez C, Iannella G, Locatello LG, Saibene AM, Leigh SJ, Ingrassia A, Nocera F. Effectiveness of submucosal turbinoplasty in refractory obstructive rhinitis: a prospective comparative trial. Eur Arch Otorhinolaryngol. 2022;279(9):4397–406.CrossRefPubMed
24.
Tseng ES, Zolin SJ, Young BT, Claridge JA, Conrad-Schnetz KJ, Curfman ET, Wise NL, Lemaitre VC, Ho VP. Can educational videos reduce opioid consumption in trauma inpatients? A cluster-randomized pilot study. J Trauma Acute Care Surg. 2021;91(1):212–8.CrossRefPubMedPubMedCentral
25.
Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ, David T. Impact of preoperative education on pain outcomes after coronary artery bypass graft Surgery. Pain. 2004;109(1–2):73–85.CrossRefPubMed
26.
Xu H, Shen Z, Gu Y, Hu Y, Jiang J, Li X, Zhao Y, Zhu M, Li J. Nasal splinting and mouth breathing training reduce emergence delirium after endoscopic sinus Surgery: a randomized controlled trial. BMC Anesthesiol. 2023;23(1):302.CrossRefPubMedPubMedCentral
27.
Lee KI, In SM, Kim JY, Hong JY, Han KD, Kim JS, Jung YG. Association of nasal septal deviation with the incidence of anxiety, depression, and migraine: a national population-based study. PLoS ONE. 2021;16(11):e0259468.CrossRefPubMedPubMedCentral
28.
Maniaci A, Ferlito S, Lechien JR, Di Luca M, Iannella G, Cammaroto G, Cannavicci A, Pollicina I, Stilo G, Di Mauro P, et al. Anxiety, depression and sleepiness in OSA patients treated with barbed reposition pharyngoplasty: a prospective study. Eur Archives oto-rhino-laryngology: Official J Eur Federation Oto-Rhino-Laryngological Soc (EUFOS) : Affiliated German Soc Oto-Rhino-Laryngology - Head Neck Surg. 2022;279(8):4189–98.
Metadata
Title
Effect of preoperative patient education and simulated mouth breathing training on opioid requirements in the post-anesthesia care unit after nasal surgery: a randomized controlled study
Authors
Yu Jeong Bang
Sojin Kim
Jin Kyoung Kim
Hara Kim
Seungmo Kim
Chi Song Chung
Seung Yeon Yoo
Heejoon Jeong
Boram Park
Sang Hyun Lee
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02310-x

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