Pain Management After Transnasal Transsphenoidal Surgery for Pituitary Adenomas
Pain Management After Transnasal Transsphenoidal Surgery for Pituitary Adenomas
We hypothesize that the effects of non-steroidal anti-inflammatory drugs (NSAIDS) for pain
 relief among patients with pituitary adenomas undergoing transnasal transsphenoidal surgeries
 are non-inferior to tramadol. We aim to launch a single-center randomized clinical trial to
 verify this hypothesis.
Postoperative pain is an important clinical concern and quality-of-care metric, yet it is
 undertreated in neurosurgical patients. Approximately 40% of inpatients complain of severe
 pain postoperatively, and only 56% of these patients indicate that their pain is well
 controlled. In addition, pain is a common cause of delayed discharge and unplanned hospital
 readmission.

 Pituitary adenoma is the second most common benign primary central nervous system tumor, and
 transnasal transsphenoidal (TTS) has long taken over craniotomy to be the first-line surgical
 approach for pituitary tumor resection. TTS significantly reduces patient's surgical trauma,
 shortens the operation time, reduces surgery-related complications, and increases total tumor
 resection rate compared with the previously used craniotomy. However, given that the nasal
 mucosa is extremely sensitive, the feeling of pain is more obvious after surgery via TTS
 approach than via craniotomy.

 Opioids such as morphine and pethidine are the most effective post-surgical analgesics, but
 they have a series of side effects, such as drug addiction, decreased gastrointestinal
 motility, nausea and vomiting. Opioids are not an analgesic that must be used after TTS
 surgery. NSAIDS, such as parecoxib and lexone, and tramadol are also commonly used analgesics
 after surgery, and they are also effective. NSAIDS is a first-tier painkiller, and tramadol
 is a second-tier drug. There is no evidence-based evidence recommending the preferred choice
 of these two drugs. Which of NSAIDS and tramadol has the better analgesic effect and which
 drug brings lower side effects to patients is still unclear. The clinical application of the
 two drugs is entirely based on the personal habits of the surgeon.

 Therefore, we plan to conduct a prospective randomized controlled trial to explore: whether
 the analgesic effect of NSAIDS is non-inferior than tramadol; and whether the side effects of
 NSAIDS are not higher than tramadol. This result will guide us in clinical pain management
 for patients with pituitary adenomas after surgery via TTS approach.
Inclusion Criteria:

 -  Patients with pituitary adenomas that need transnasal transsphenoidal surgery

 -  Patients of either gender aged 18 to 70 years

 Exclusion Criteria:

 -  Patients with rhinitis, sinusitis, deviated nasal septum, etc. that can cause nasal
 pain

 -  Patients with medical history of digestive ulcer/gastrointestinal bleeding

 -  Patients with heart disease, severe liver and kidney dysfunction

 -  Pregnant patients

 -  Patients allergic to NSAIDs or tramadol

 -  Patients who need long-term treatment of NSAIDs or analgesic for other reasons

 -  Patients whose postoperative paraffin pathology suggests non-pituitary adenoma

 -  Patients who have not undergone transsphenoidal surgery

 -  Patients who reject to enter the group or ask to leave the group after entry