Introduction: Conventional agents such as opioids and benzodiazepines may control symptoms but can impair recovery and pose airway-related risks. Dexmedetomidine offers sedative, analgesic, and sympatholytic benefits with minimal respiratory depression. The aim of this trial was to evaluate intraoperative dexmedetomidine for reducing emergence agitation and postoperative pain after traumatic nasal surgery.

Material and methods: This prospective, double-blind randomized controlled trial at Imam Reza Hospital included 60 patients undergoing traumatic nasal surgery, randomized equally to receive either intraoperative dexmedetomidine or saline placebo. Dexmedetomidine was administered as a 1 µg/kg loading dose followed by a 0.5 µg/kg/h infusion. Primary outcomes were postoperative agitation and pain severity, while secondary outcomes included hemodynamic changes, recovery duration, rescue analgesic use, and adverse events.

Results: Dexmedetomidine significantly reduced postoperative emergence agitation and pain scores at all assessed time points compared with placebo. It also attenuated heart rate and mean arterial pressure during early recovery without affecting oxygen saturation. Although dexmedetomidine prolonged extubation time and PACU stay, it did not significantly increase major adverse events and was associated with a lower incidence of postoperative shivering.

Conclusion: In conclusion, intraoperative infusion of dexmedetomidine during traumatic nasal surgery significantly attenuates emergence agitation and mitigates postoperative pain severity, while ensuring superior hemodynamic stability in the early recovery phase.