Retrospective evaluation of postoperative pain-nausea vomiting-delirium and agitiation in rhinoplasty cases

Aim: Rhinoplasty is an operation to reshape the nose without impairing its functions or by correcting the impaired functions (1,2). It is performed under general anesthesia in our clinic and infiltration anesthesia is applied by the surgeon. As in all patients under general anesthesia, postoperative pain, nausea and vomiting due to secretions, nasal tampons or general anesthesia, and recovery agitation may be observed in rhinoplasty cases as well as surgical complications. In this study, we aimed to investigate the intraoperative hemodynamic changes seen in rhinoplasty cases, the effectiveness of analgesic, antiemetic and anxiolytic drugs used on postoperative pain, nausea and vomiting and delirium agitation, and to reveal the risk factors of POBC, pain, delirium and agitation, which significantly affect postoperative patient comfort. Material and Methods: In this retrospective study, with the permission of the Ethics Committee (Ethics Committee approval; 04/12/2023 date, decision no. 6) and the archive search permission of the Farabi Hospital Chief Physician's Office 48814514, the data of 155 patients who underwent rhinoplasty in the ENT department of Karadeniz Technical University Faculty of Medicine Farabi Hospital between 01.01.2023-01.06.2023 were analyzed in the hospital database and archive file records. Data on patient characteristics (age, weight, ASA class, comorbidities), analgesic, antiemetic, anxiolytic consumption, and procedure-related durations (anesthesia and surgery duration) were obtained from patient files and hospital data recording system. The effects of intraoperative hemodynamic variations on postoperative nausea, vomiting, pain and delirium agitation were evaluated according to the need for additional medication in the recovery room with data obtained from noninvasive blood pressure and heart rate recordings. Patients with a history of smoking in the preoperative period and comorbidities were also analyzed according to the need for postoperative medication for nausea/vomiting, pain and delirium agitation. Recovery room hemodynamic data and the need for medication were evaluated in terms of nausea/vomiting, pain and delirium agitation. Medications administered for nausea and vomiting, pain and delirium agitation in the first 6 hours postoperatively were analyzed from ward order records and all data were recorded. Results: Patients who received meperidine and intraoperative dexmedotomidine infusion for postoperative analgesia had less postoperative pain than patients who received tramadol (Table 14), and patients who had postoperative pain had more postoperative nausea and vomiting and delirium agitation (Table 14); patients who smoked in the preoperative period and who were administered intraoperative meperidine had less nausea and vomiting compared to patients who were administered tramadol, whereas patients with postoperative nausea and vomiting had more pain and delirium agitation (Table 8); we observed that recovery room heart rate and SAB were significantly higher in patients with postoperative delirium agitation, postoperative delirium agitation was less in patients who received intraoperative meperidine and dexmedotomidine infusion compared to patients who received tramadol, and postoperative nausea and vomiting and pain were more in patients with postoperative delirium agitation (Table 15). Conclusion: In our study, it was concluded that postoperative pain, POVN and delirium agitation are interrelated; meperidine, which is preferred for intraoperative analgesic purposes, is more effective in preventing postoperative pain, POVN and delirium agitation compared to tramadol; intraoperative initiation and maintenance of dexmedotomidine infusion may reduce the frequency of POVN and delirium agitation; however, taking preventive measures by identifying the risk factors for POVN in the preoperative period will reduce the rate of postoperative complications. Key Words: Rhinoplasty, pain, POVN (postoperative nausea and vomiting), delirium, agitation, meperidine, tramadol, dexmedotomidine.