Original Article

Comparison of the Effects of Dexmedetomidine and Remifentanil in Reducing Bleeding During Paranasal Sinus Surgery: A Double- Blind Randomized Clinical Trial

Dexmedetomidine and Remifentanil for Paranasal Sinus Surgery Bleeding

Abstract

Background: Intraoperative bleeding is a challenge in functional endoscopic sinus surgery (FESS). This study
aimed to compare the effects of Dexmedetomidine and Remifentanil on intraoperative bleeding, hemodynamic
stability, and postoperative pain in patients undergoing paranasal sinus surgery.
Methods: In this randomized controlled trial, 100 adult patients undergoing paranasal sinus surgery were randomly assigned to receive either Dexmedetomidine (0.2 μg/kg/h) or Remifentanil (0.25 μg/kg/min) by
continuous intravenous infusion during surgery. General anesthesia was administered in both groups. The
primary outcome was intraoperative blood loss, assessed both by volume (in milliliters) and bleeding severity
(on a 5-point Likert scale). Secondary outcomes included systolic and diastolic blood pressure, heart rate, Visual
Analog Scale (VAS) pain scores, and surgery duration.
Results: There was no significant difference in mean intraoperative blood loss between groups
(Dexmedetomidine:114.76 ± 1 26.65 mL vs. Remifentanil: 119.20 ± 47.28 mL; p = 0.81). However, bleeding
severity was significantly lower in the Dexmedetomidine group, with 76% experiencing mild bleeding compared to 56% in the Remifentanil group, and 16% in the latter experiencing severe bleeding (p = 0.008). Postoperative VAS pain scores were significantly lower in the Dexmedetomidine group (2.04 ± 0.53 vs. 3.12 ± 1.08; p < 0.001). Hemodynamic parameters decreased substantially over time in both groups, with no clinically significant
intergroup differences, except at isolated time points.
Conclusions: While both Dexmedetomidine and Remifentanil effectively maintained hemodynamic stability
during FESS, Dexmedetomidine resulted in milder bleeding severity and better postoperative analgesia,
supporting its use as a preferred agent for controlled hypotension in sino-nasal surgery.

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SectionOriginal Article(s)
Keywords
Dexmedetomidine Remifentanil Controlled Hypotension Functional Endoscopic Sinus Surgery Intraoperative Bleeding Postoperative Pain
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How to Cite
1.
Ahsan B, Ghaderi Q, Maghsomi N, Rahmani K, Ebnerasooli S, Naseri K, Azad Majedi M. Comparison of the Effects of Dexmedetomidine and Remifentanil in Reducing Bleeding During Paranasal Sinus Surgery: A Double- Blind Randomized Clinical Trial. AJS. 2025;8(4):120-127.