Efficacy of External Nasal Nerve Block in Prevention of Postoperative Agitation Following Nasal Surgeries

Al Jedaani Hospital100 enrolled

Overview

Emergence agitation following general anaesthesia may lead to serious complications like self-extubation or removal of catheters, which can lead to hypoxia, aspiration pneumonia, bleeding or reoperation. Nose surgery is associated with a higher incidence of emergence agitation. The investigators planned to evaluate the efficacy of external nasal nerve block in prevention of postoperative agitation following external nasal surgeries under general anesthesia(GA).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

100

Conditions

Agitation States as Acute Reaction to Gross Stress

Interventions

External nasal nerve blockPROCEDURE

Three single (midline injection) and 4 paired (bilateral injection) sites to block the external nasal sensation.

saline adrenalineDRUG

Xylocaine, adrenalineDRUG

Eligibility

Sex: ALLMin age: 20 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * 110 adult patients of ASA physical status I and II, * Age 20-60 years, * Scheduled for elective external nasal surgeries in which nasal packing on each side was used postoperatively for 24 hours. Exclusion Criteria: 1. History of uncontrolled hypertension, 2. Ischemic or valvular heart disease, 3. Use of MAO inhibitors or adrenergic blocking drugs, 4. Cognitive impairment, 5. Patients taking antipsychotics, 6. Renal insufficiency or liver dysfunction

Locations (1)

Al Jedaani group of hospitals

Jeddah, Meccah, Saudi Arabia

Outcomes

Primary Outcomes

postoperative agitation

Assessment done using Richmond agitation- sedation scale (RASS)

Time frame: Emergence is defined as the time interval from discontinuation of anesthesia to 5 min after extubation.

Quality of recovery

Time frame: 24 hours postoperative

Secondary Outcomes

dose of fentanyl

Fentanyl boluses were given in response to changes in hemodynamics (more than 15% increases in MAP and HR than the baseline values taken after induction by 5 minutes)

Time frame: intraoperative period in minutes

morphine dose in PACU

equivalent morphine dose in PACU (calculated using opioid:morphine equivalents of 100 µg i.v. fentanyl to 10 mg i.v. morphine; 75- 100 mg IV pethidine to 10 mg i.v. morphine

Time frame: one hour in PACU

Nausea and vomiting in PACU

Four-point nausea and vomiting scale (0=no nausea; 1=mild nausea; 2=severe nausea requiring antiemetics; and 3=retching, vomiting, or both) was also evaluated

Time frame: one hour in PACU

Extubation time

Time frame: Up to 15 after discontinuation of anesthesia

Surgical time

intraoperative

Time frame: duration of surgery in minutes up to 3 hours

first verbal response time

period from discontinuation of anesthesia 'time zero' to 1st verbal response in minutes

Data from ClinicalTrials.gov

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