Effects of preemptive acetaminophen administration and preoperative anxiety on postoperative agitation and pain in adult septorhinoplasty patients

Background Preoperative anxiety and postoperative agitation are common in otolaryngologic surgeries such as septorhinoplasty and may adversely affect patient outcomes. Although preemptive acetaminophen is frequently used to reduce postoperative pain, its effects on agitation remain unclear. This study aimed to investigate the relationship between preoperative anxiety and postoperative agitation and pain, as well as the effect of preemptive intravenous acetaminophen administration in adult septorhinoplasty patients. Methods This prospective, randomized study was conducted between March and September 2020 at Zonguldak Bulent Ecevit University Hospital after ethics approval (protocol no: 2020/04). Eighty-six, ASA I–II adult patients (aged 18–65 years) undergoing elective septorhinoplasty were included. Patients were randomized into two groups: Group 1 received 1 g intravenous acetaminophen 30 minutes before induction, and Group 2 received it 15 minutes before the end of surgery. Preoperative anxiety was assessed using the Beck Anxiety Inventory (BAI), postoperative agitation with the Riker Sedation-Agitation Scale (RSAS), and postoperative pain with the Numeric Rating Scale (NRS) at 0, 5, 10, and 15 minutes postoperatively. p < 0.05 was considered statistically significant. Results The groups were comparable in demographic and intraoperative variables. Moderate-to-severe anxiety was observed in 2.3% of all patients. NRS scores were significantly lower in Group 1 at the 5th postoperative minute (p < 0.05), whereas no significant differences were found in RSAS scores at any time point. RSAS and NRS scores decreased over time in both groups. No significant correlations were detected between preoperative anxiety and postoperative agitation or pain. Conclusions Preemptive acetaminophen administration reduced early postoperative pain but had no significant effect on postoperative agitation in adult septorhinoplasty patients. Low levels of preoperative anxiety did not influence agitation or pain outcomes. Individualized analgesic strategies and multimodal approaches may provide more effective perioperative management in nasal surgeries. Trial registration: ClinicalTrials.gov Identifier: NCT07010042.