Guanfacine for PONV and Pain After Sinus Surgery

Not Applicable

Completed

Brief Summary: Postoperative nausea and vomiting (PONV) and pain are the most common causes of Post Anesthesia Care Unit (PACU) discharge delay, with untreated PONV occurring in 20-30% of post-surgical patients. The effect of guanfacine (GF) administration on pain and nausea scores will be assessed with two groups. One group will receive 1 mg of GF to take orally and the other group will receive a similar appearing placebo (containing no drug) to take orally.

Detailed Description: Pain after surgery is commonly treated with narcotics which can potentiate PONV, further delaying PACU discharge. In multiple studies, alpha-2 agonists such as clonidine and dexmedetomidine reduce both the incidence of PONV and post-op pain, as well as requirements for postoperative analgesics. These actions are mediated via central alpha-2A receptors (A2AR). Of the A2AR agonists, guanfacine, though a weak antihypertensive agent, has the highest selectivity for the A2AR, but to date is untested for its potential to treat either PONV or post-operative pain.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Inability to read and freely consent
Patients who take alpha-2 agonists routinely (guanfacine, clonidine, tizanidine)
Patients undergoing sinus surgery planned for greater than 3 hours
Patients with significant pre-existing pain, on chronic pain (opioid, methadone) therapy, severe fibromyalgia or other pre-existing pain condition in any body part
Patients with preoperative nausea/vomiting at baseline.
Pregnant or lactating women

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Placebo with a similar appearance to guanfacine by mouth one time prior to surgery
Guanfacine	Guanfacine	Guanfacine 1 mg capsule by mouth, one time prior to surgery.

Primary Outcome Measures

Name	Time	Method
Comparison of PONV Score of Assessments Done at 30 Minutes After Arrival in PACU Using 11-point Nausea Scale (nVRS)	30 minutes after arriving in PACU	Comparison of PONV Score of assessments done at 30 minutes after arrival in PACU using the nVRS when 0 is no nausea and 10 is worst nausea
Comparison of PONV Score of Assessments Done at 60 Minutes After Arrival in PACU Using 11-point Nausea Scale (nVRS)	60 minutes after arriving in PACU	Comparison of PONV Score of assessments done at 60 minutes after arrival in PACU using the nVRS when 0 is no nausea and 10 is worst nausea
Comparison of PONV Score of Assessments Done at 15 Minutes After Arrival in PACU Using 11-point Nausea Scale (nVRS)	15 minutes after arriving in PACU	Comparison of PONV Score of assessments done at 15 minutes after arrival in PACU using the nVRS when 0 is no nausea and 10 is worst nausea
Postoperative Nausea Assessment Using 11-point Nausea Scale (nVRS)	24 hours post op	PONV assessed using nVRS at 24 hours postop when 0 is no nausea and 10 is worst nausea.

Secondary Outcome Measures

Name	Time	Method
Maximum Postoperative Pain Assessment Using 11-point Visual/Verbal Analog (VAS)	15, 30, 60 minutes after arriving in PACU	Maximum postoperative pain assessment assessed in PACU at 15, 30 and 60 minutes after PACU arrival using VAS when 0 is no pain and 10 is worst pain
Postoperative Pain Assessment Using 11-point Visual/Verbal Analog (VAS)	24 hours postop	Postoperative pain assessment using VAS at 24 hours postop when 0 is no pain and 10 is worst pain
PACU Length of Stay in Minutes	Time frame between arrival and discharge in PACU, approximately 90 minutes
Number of Doses of PONV Treatment Administered in PACU	Time frame between arrival and discharge in PACU, approximately 90 minutes
Total Narcotic Requirement in PACU	Time frame between arrival and discharge in PACU, approximately 90 minutes	Total narcotic requirement in PACU tallied in morphine equivalents during PACU stay