Regional Anesthesia to Reduce Opioid Use Following FESS

Opioid analgesics are prescribed for moderate to severe acute pain; however, there are
contraindications, cautions, and side effects that are common with all opioids. Dependence
and tolerance are also likely with regular opioid use, resulting in the current nationwide
opioid epidemic. In Alabama alone, there were 343 opioid-related overdose deaths in 2016, 124
of which were related to prescription opioids. Alabama providers have the highest prescribing
rate in the country, nearly twice the national rate, per the NIH/NIDA website. In 2015, the
Centers for Disease Control (CDC) released prescribing guidelines relating to chronic pain,
and in 2018 Alabama's Blue Cross/Blue Shield insurance group limited the supply of opioids
allowed to their members to 7 days.

There is currently no clinical guideline for prescribing post operative opioid medications
for functional endoscopic sinus surgery (FESS). A 2018 survey documenting prescribing
patterns by 168 members of the American Rhinologic Society found that most physicians who
participated prescribed, on average, 27 opioid pain pills for patients after surgery. Prior
studies have been performed to help decrease the pain patient's feel after sinus surgery.
Haytoglu in 2016 revealed that adding non-absorbable sinus packs loaded with local
anesthetics such as bupivacaine achieved less pain values and improved patient satisfaction
scores.

Given this current data the investigators believe injecting patients with a long acting
analgesic during the procedure will help reduce post-operative pain. If the investigators can
decrease the amount of pain patients have in the post-operative period, they can
theoretically decrease the number of opioid pain pills prescribed. The investigators plan to
also track the number of opioid pills consumed by patients in the post-operative period to
obtain a somewhat uniform prescribing pattern within surgeons.

Inclusion Criteria:

- Age 18 years or older

- Able to sign informed consent form

- Able to comply with all study procedures and availability for the duration of the
study

- Able to speak English

- Diagnosis of chronic rhinosinusitis

- Scheduled to receive functional endoscopic sinus surgery (FESS) at UAB

Exclusion Criteria:

- Current use of opioid medication

- Known allergic reactions to components of the study intervention

- History of IV drug use or abuse

- History of opioid abuse

- History of chronic pain disorder

- Treatment with another investigational drug or other intervention within 30 days