Pre-emptive Dexmedetomidine Versus Magnesium Sulfate for Postoperative Analgesia in Nasal Surgery: A Prospective Comparative Study

Background and objective: Dexmedetomidine and magnesium sulfate are commonly used during nasal surgery to provide controlled hypotension.This study compared their effects on postoperative analgesia.The primary outcome was postoperative pain assessed using the Visual Analogue Scale (VAS).Secondary outcomes included hemodynamic parameters, time to first rescue analgesic and total rescue analgesic consumption, and patient satisfaction.Materials and methods: This prospective, non-randomized comparative study included 75 patients with American Society of Anesthesiologists (ASA) physical status I-II undergoing nasal surgery under general anesthesia.Eligible patients were enrolled consecutively and observed across three exposure groups of 25 each, categorized according to the adjuvant selected by the treating anesthesiologist as part of routine clinical practice.Group D received a dexmedetomidine 0.5 µg/kg IV bolus administered over 10 minutes, 15 minutes before induction, followed by an infusion at 0.25 µg/kg/hour from induction until 15 minutes before the end of surgery.Group M patients received magnesium sulfate 40 mg/kg diluted in 100 mL normal saline administered IV over 15 minutes before induction, while group C received no anesthetic adjuvants and served as controls.We recorded VAS scores, hemodynamic variables, and rescue analgesics at predefined intervals up to 24 hours postoperatively.Results and conclusion: Postoperative VAS scores were significantly lower with dexmedetomidine than with magnesium sulfate at one to two hours (0.64±0.76 vs 2.04±0.84;1.24±0.78vs 2.60±1.47;p <0.001), and both groups were lower than controls in the first six hours (p <0.05).Time to first rescue analgesia was longer with dexmedetomidine (285±46.63 min) than with magnesium sulfate (147.27±49.21min; p <0.001), with lower analgesic consumption and higher patient satisfaction (p <0.001).Pre-emptive dexmedetomidine was associated with improved postoperative analgesia and reduced rescue analgesic requirement after nasal surgery.