Evaluation of the efficacy of bilateral sphenopalatine ganglion block in endoscopic sinus surgery under general anesthesia: a randomized prospective controlled trial

Bhattacharyya, Susmita; Tewari, Mandeep K; Ghosh, Shubhamoy; Chakroborty, Jayanta; Das, Writuparna; Barman, Utpal

doi:10.4103/2356-9115.195878

Cited by 12 publications

(21 citation statements)

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“…The surgery and SPGB through EETA are supported by recent technological advancements, have been increasingly used over the last decade for the treatment of pituitary adenoma. 1,2,[6][7][8][9][10][15][16][17][18][19][20][21][22] The main goal of blood pressure control during ETSS was to achieve a dry surgical field to improve visibility and facilitate the surgical approach without complication. In the current study, the MAP, HR was maintained at target levels, with no significant differences between the two groups but it was non-fluctuated in the SPGB group by adjustment the ventilatory support and balanced anesthesia with no or minimal consumption of hypotensive agents compared to control group.…”

Section: Discussionmentioning

confidence: 99%

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

Mohamed

Elkholy

Eissa

et al. 2020

Al-Azhar International Medical Journal

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Background: The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods: Thirty patients(ASA I-II)aged 22-55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine (SPGB group) or sterile normal saline (control group). Mean arterial blood pressure was maintained at 60-70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of the first request for analgesia, the total dose of meperidine consumption in the first 24hours postoperatively, patient's satisfaction and postoperative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P<0.001), ACS(P<0.01), nitroglycerine consumption(P<0.0001)and emergence time(P< 0.001). At PACU, visual analog pain score were lower in SPGB at 0,1,6(P<0.001), there were a high difference between two groups in B-endorphin levels(P<0.001)and also in dose of meperidine, % of patients needs analgesia and patients satisfaction(P<0.002), Conclusion: Use of sphenopalatine ganglion block with general anesthesia is a safe and effective technique, it contributes in adequate intra and postoperative analgesia needed for stabilization of hemodynamics with less blood loss, improving the quality of surgical field instead of controlled hypotensive technique during endoscopic endo-nasal trans-sphenoidal hypophysectomy.

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Section: Discussionmentioning

confidence: 99%

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

Mohamed

Elkholy

Eissa

et al. 2020

Al-Azhar International Medical Journal

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“…Sphenopalatine branches of maxillary nerve give the sensory roots while the deep petrosal gives the sympathetic nerve roots. 18 The SPG regulates the nasal mucosal blood flow as the preganglionic parasympathetic fibers derived from the greater petrosal branch of the facial nerve synapse with neurons here. 18 Hence, SPGB regulates the blood supply of the ethmoid, sphenoid, and frontal sinuses, which are supplied by the ethmoidal artery and the supraorbital artery, the branches of the internal carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…18 The SPG regulates the nasal mucosal blood flow as the preganglionic parasympathetic fibers derived from the greater petrosal branch of the facial nerve synapse with neurons here. 18 Hence, SPGB regulates the blood supply of the ethmoid, sphenoid, and frontal sinuses, which are supplied by the ethmoidal artery and the supraorbital artery, the branches of the internal carotid artery. 18 The sympathetic tone can be reduced by intravenous agents like propofol which helps in diminishing circulation in nasal cavity and sinuses, improving the ease of surgery with a clear hemostatic field.…”

Section: Discussionmentioning

confidence: 99%

“…18 Hence, SPGB regulates the blood supply of the ethmoid, sphenoid, and frontal sinuses, which are supplied by the ethmoidal artery and the supraorbital artery, the branches of the internal carotid artery. 18 The sympathetic tone can be reduced by intravenous agents like propofol which helps in diminishing circulation in nasal cavity and sinuses, improving the ease of surgery with a clear hemostatic field. 18 Also some studies have shown no significant differences with concern to intraoperative bleeding using isoflurane and propofol.…”

Section: Discussionmentioning

confidence: 99%

“…18 The sympathetic tone can be reduced by intravenous agents like propofol which helps in diminishing circulation in nasal cavity and sinuses, improving the ease of surgery with a clear hemostatic field. 18 Also some studies have shown no significant differences with concern to intraoperative bleeding using isoflurane and propofol. 19 Cho et al reported that SPG block has limited utility for postoperative analgesia in patients undergoing functional endoscopic sinus surgery (FESS).…”

Section: Discussionmentioning

confidence: 99%

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Regional Anesthesia as Supplementation to General Anesthesia in Endonasal Surgeries

Naik¹

2019

Journal on Recent Advances in Pain

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Background: Endoscopic surgeries are minimally invasive surgeries to treat sinus pathologies. The challenges faced by the anesthesiologist are to provide bloodless field of surgery, to maintain hemodynamic stability, and to reduce anesthetic supplementation to facilitate early recovery of the patient. The preferred anesthesia is general with controlled ventilation, stable surgical field, and airway protection with adequate anesthesia. Problems faced during the procedure are to keep the minimum the bleeding during surgery so that a better visibility of the endoscopic magnified surgical field, faster awakening after reversal of general anesthesia, faster return of protective airway reflexes, and optimal postoperative analgesia. Sphenopalatine ganglion block (SPGB) has proven an effective adjuvant to general anesthesia during sinonasal surgery. Reduced bleeding increases visibility and reduces operative time with reduced complications and better results. In our study, SPGB was supplemented with the general anesthesia to evaluate the comfort of operability, opioid supplementation, inhalation anesthetic requirement, and intraoperative and postoperative complications. Materials and methods: Our study is a randomized controlled triple-blind study with 30 patients in each group. In both the groups, general anesthesia was given. In group I, SPGB was given with a 10 mL of 1% xylocaine local anesthetic, and in group II, SPGB was given with placebo. Results:We have observed that there is a reduced intraoperative and postoperative bleeding in group I, the field of vision is better in group I, and fentanyl supplementation and isoflurane consumption was less in group I. The intraoperative and postoperative complications were less in group I. Conclusion: Sphenopalatine ganglion block regional anesthesia is reliable supplementation to general anesthesia in endonasal endoscopic procedures to provide stable surgical field with reduced anesthetic requirement and minimal intraoperative and postoperative complications.

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Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery

Hamouda

Salama

Hassan

et al. 2023

Egyptian Journal of Anaesthesia

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Evaluation of the efficacy of bilateral sphenopalatine ganglion block in endoscopic sinus surgery under general anesthesia: a randomized prospective controlled trial

Cited by 12 publications

References 0 publications

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

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

Regional Anesthesia as Supplementation to General Anesthesia in Endonasal Surgeries

Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery

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