The effectiveness of endoscopic sphenopalatine ganglion block in management of postoperative pain after septal surgery

Abstract

Background: This study evaluated the effect of bilateral endoscopic sphenopalatine ganglion block (SPGB) for management of postoperative pain in patients undergoing septoplasty.Methods: Sixty septoplasty patients (51.7% male, 48.3% female, aged 18 to 45 years) were randomly assigned to general anesthesia (GA) alone (control) (n = 30) or GA plus endoscopic SPGB (n = 30). Demographic data, duration of surgery, blood loss, postoperative visual analogue scale (VAS) pain scores (upon arrival at the postanesthesia care unit [PACU] and 2, 6, 12, and 24 hours after surgery), overall analgesic usage (end of 24 and 168 hours a er surgery), overall satisfaction with the pain control (end of 24 and 168 hours a er surgery), and complications (bleeding, nausea and vomiting, and visual disturbance) were recorded.Results: Pain scores upon arrival to the PACU and 2, 6, 12, and 24 hours a er surgery were significantly lower in the SPGB group compared to the control group (p < 0.001). Moreover, the SPGB group had significantly lower anal-gesic requirements and higher satisfaction scores with their pain control at the end of 24 and 168 hours a er surgery compared to the control group (p < 0.001). The 2 groups significantly differed in terms of intraoperative blood loss (p = 0.024), and surgery time was longer in the SPGB group compared to the control group (p < 0.001).Conclusion: SPGB with bupivacaine is a safe and effective method to reduce pain a er septoplasty, and it is a costeffective alternative to high doses of analgesics. C 2019 ARS-AAOA, LLC. How to Cite this Article: Ekici NY, Alagöz S. The effectiveness of endoscopic sphenopalatine ganglion block in management of postoperative pain a er septal surgery. Int Forum Allergy Rhinol. 2019;9:1521-1525.E ffective management of postoperative pain is a critical component of nasal surgery. Insufficient pain management can lead to poor outcomes, including decreased patient satisfaction, long-term hospitalization and delayed resumption of work, treatment with high doses of analgesics, and increased healthcare costs. Despite considerable improvements in analgesia and surgical techniques, there is no consensus for pain control and avoidance of overprescription after nasal surgery. Numerous pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDS), gabapentin with or without intravenous dexamethasone,

The efficacy of bilateral sphenopalatine ganglion block under general anesthesia in trans-sphenoidal endoscopic hypophysectomy

“…These varieties in results might come from the different methods for control of intraoperative hemodynamics between nitroglycerine consumption or inhalational anesthesia, different types of bblockers and opioids. As regards postoperative complication, our results presented by PONV {6 patient(40%) in control group versus 2 patients(6.6%) in SPGB group and 9 patient(60%) in control group suffered from postoperative headache versus no one patient in SPGB group, contralateral to these results, some studies 9,20,23,24 found no significant difference between two groups, on other hand our results coincide with the previous studies 16,18,21,22 , who found higher prevalence of PONV and headache in the control group than in the SPGB group. In this study, the patient's satisfaction was higher in the SPGB group than the control group and also, all previous studies mentioned in this discussion either agreed with or was against the rest of our study found the patient's satisfaction was higher in SPGB group than the control group.…”

Comparison of postoperative analgesia between greater palatine nerve block with local infiltration and local infiltration alone in septoplasty surgeries

“…10 In the study by Ekici et al, the post-operative pain scores were analyzed by the VAS scale as in our study but at the timelines as in immediate post-operative, 2 nd , 6 th , 12 th and 24 th post-operative hours. 5 The patients who had received the additional SPG block had significantly less pain as per VAS in each of the assessed time in comparison with those who had only GA. The scores were 1.47 at the immediate post op for those who received the regional nerve block which gradually reduced to 0.77 at the 24 th post op hour, whereas the other group were at 4.73 decreasing to 3.77 during the same timeline of assessment.…”

“…Ekici et al had studied the effect of endoscopic sphenopalatine ganglion block in management of post-operative pain after septal surgery by studying those operated under GA only and those with GA along with SPG block. 5 The combined effect of greater palatine nerve block and anterior ethmoidal nerve block in various nasal surgeries including septoplasty, FESS and SMR has also been studied by Chitra et al 6 Cochrane review by Fujiwara et al on Perioperative local anesthesia for reducing pain following septal surgery also had analyzed the role of SPG block. 7 The effect of SPG block in management of post-operative pain following FESS surgery had been studied in various researches including those by Rezaeian et al and Samuel et al 8,9 Systematic reviews and meta-analysis by Kim et al had validated the effective reduction of intra and post op pain by use of SPG block in endoscopic sinus surgeries.…”

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

“…Ekici et al performed a randomized control trial examining the effect of bilateral sphenopalatine ganglion (SPG) blocks in the management of postoperative pain following septoplasty. They found that the SPG group had significantly reduced pain, reduced analgesic use, and improved patient satisfaction compared to the placebo arm 14 . Similar findings have been shown with an infratrochlear and infraorbital nerve block 15 for septorhinoplasty.…”