Opioid-Free vs Opioid-Based Anesthesia for Nasal Surgeries

Postoperative pain intensity will be assessed using the Visual Analog Scale for Pain (VAS), which ranges from 0 to 10, where 0 = no pain and 10 = worst imaginable pain. Higher scores indicate worse pain.

Baseline pain score will be defined as the VAS score measured immediately after arrival to the post-anesthesia care unit (PACU). The primary outcome will be the change from baseline in VAS pain scores at each postoperative assessment time point, comparing opioid-free and opioid-based anesthesia approaches

Mean arterial pressure (MAP), measured in mmHg, will be used to assess perioperative hemodynamic changes associated with opioid-free versus opioid-based anesthesia. Baseline MAP will be defined as the measurement obtained before study drug infusion. The secondary outcome will be the change from baseline in MAP at each specified time point. MAP will be calculated using the standard formula:

MAP = (Systolic Blood Pressure + 2 × Diastolic Blood Pressure) / 3.

Heart rate (HR), measured in beats per minute (bpm), will be recorded to assess perioperative hemodynamic responses. Baseline HR will be defined as the measurement obtained before study drug infusion. The secondary outcome will be the change from baseline in HR at each specified time point.

Quality of recovery will be assessed using the Quality of Recovery-40 questionnaire (QoR-40), a validated patient-reported outcome measure consisting of 40 items across five domains (emotional state, physical comfort, psychological support, physical independence, and pain). The total score ranges from 40 to 200, where higher scores indicate better quality of recovery.

Baseline QoR-40 will be defined as the score obtained preoperatively. The secondary outcome will be the change from baseline in total QoR-40 score comparing opioid-free and opioid-based anesthesia approaches.

The need for rescue analgesia will be assessed during the first 24 hours postoperatively. Rescue analgesia will consist of intravenous ketorolac 30 mg, administered according to the study protocol.

The secondary outcome will include:

The proportion of participants requiring rescue analgesia, and

Time to first analgesic request, defined as the time elapsed (in minutes) from the end of surgery to the first request for rescue analgesia (IV ketorolac 30 mg), and

Total rescue analgesic consumption, defined as the total dose of ketorolac (mg) administered within the first 24 hours postoperatively.

A higher proportion of participants requiring rescue analgesia, a shorter time to first analgesic request, and a greater total ketorolac consumption indicate worse postoperative analgesia.

The incidence and severity of postoperative nausea and vomiting (PONV) will be assessed at 30 minutes, 60 minutes, 90 minutes, and 2 hours postoperatively using a three-point scale:

0 = none

I = mild

II = severe

Both the proportion of participants experiencing PONV and the severity score at each time point will be recorded. Higher scores indicate more severe PONV.

Patient and surgeon satisfaction with the surgical and anesthetic experience will be assessed using a five-point Likert scale, where:

• = Very dissatisfied
• = Dissatisfied
• = Neutral
• = Satisfied
• = Very satisfied

Satisfaction scores will be recorded separately for patients and surgeons at 24 hours postoperatively. Higher scores indicate greater satisfaction.

Sedation levels will be assessed using the Ramsay Sedation Score (RSS), a validated scale ranging from 1 to 6, where:

• = Anxious and agitated or restless
• = Cooperative, oriented, and tranquil
• = Responds to commands only
• = Brisk response to light glabellar tap or loud auditory stimulus
• = Sluggish response to light glabellar tap or loud auditory stimulus
• = No response

Higher scores indicate deeper sedation. Sedation will be recorded at 30 minutes, 60 minutes, 90 minutes, 2 hours, 4 hours, 8 hours, 12 hours, and 24 hours postoperatively.