The endoscopic binostril transnasal transsphenoidal resection of pituitary procedures often cause intense pain which is difficult to suppress at the depth of conventional general anesthesia, resulting in severe hemodynamic fluctuations in patients. Infraorbital and infratrochlear nerve block can block the pain signal caused by the endoscopic binostril transnasal transsphenoidal resection of pituitary theoretically, which has been proven to provide satisfactory analgesia after septorhinoplasty. However, whether bilateral infraorbital and infratrochlear nerve block can provide stable hemodynamics and reduce the hemodynamic fluctuation the patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary remains unclear.
Surgical stimulation is one of the important factors leading to hemodynamic fluctuation and affecting postoperative recovery quality. The endoscopic binostril transnasal transsphenoidal resection of pituitary procedures often cause intense pain because of there were numerous nerve endings at the surgical site which is originated from branches of the trigeminal nerve (including infraorbital and infratrochlear nerve). It's difficult to suppress intraoperative stimulation at the depth of conventional general anesthesia, resulting in severe hemodynamic fluctuations in patients. It's reported that pterygomaxillary fossa block can inhibit hypertension caused by surgical procedures, however the block may cause complications because of its complicated operations. Infraorbital and infratrochlear nerve block can block the pain signal caused by the endoscopic binostril transnasal transsphenoidal resection of pituitary theoretically, which has been proven to provide satisfactory analgesia after septorhinoplasty. However, whether bilateral infraorbital and infratrochlear nerve block can reduce the pain in the patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary remains unclear. Therefore, the investigators propose the hypothesis that preoperative bilateral infraorbital and infratrochlear nerve block could effectively reduce the pain in patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary. The objective of this study is to observe the heart rate and blood pressure at a specific point in time during the operation and pain at 2, 8, 24, 48 hours postoperatively between adult patients receiving or not receiving bilateral infraorbital and infratrochlear nerve block.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
120
After general anesthesia, the patients will receive bilateral infraorbital and infratrochlear nerve block 30 minutes prior to surgery. Infraorbital nerve block is performed while using an extraoral approach. A 25-gauge needle was inserted laterally to the ipsilateral nostril after palpating the infraorbital ridge to locate the infraorbital foramen. The index finger of the non-dominant hand was positioned above the infraorbital foramen, and the needle was advanced until it was felt beneath the finger. 2 ml of the 0.5% ropivacaine slowly injected after negative aspiration of blood was confirmed. Inserting the needle 1 cm above the inner canthus, targeting the junction of the orbit and the nasal bone, performed infratrochlear nerve block. After negative aspiration of blood, 1 ml of the 0.5% ropivacaine was injected. Contralateral nerve block was performed in the same manner.
Patients receiving general anesthesia without Infraorbital and Infratrochlear nerve block.
Tongji Hospital
Wuhan, Hubei, China
mean arterial pressure (MAP) before nerve block
mean arterial pressure (MAP) before nerve block
Time frame: before nerve block
heat rate (HR) before nerve block
heat rate (HR) before nerve block
Time frame: before nerve block
MAP within 10 minutes after nerve block
MAP within 10 minutes after nerve block
Time frame: within 10 minutes after nerve block
HR within 10 minutes after nerve block
HR within 10 minutes after nerve block
Time frame: within 10 minutes after nerve block
MAP before nasal mucosal dissection
MAP before nasal mucosal dissection
Time frame: before nasal mucosal dissection
HR before nasal mucosal dissection
HR before nasal mucosal dissection
Time frame: before nasal mucosal dissection
MAP immediately after nasal mucosal dissection
MAP immediately after nasal mucosal dissection
Time frame: immediately after nasal mucosal dissection
HR immediately after nasal mucosal dissection
HR immediately after nasal mucosal dissection
Time frame: immediately after nasal mucosal dissection
MAP before septum resection
MAP before septum resection
Time frame: before septum resection
HR before septum resection
HR before septum resection
Time frame: before septum resection
MAP immediately after septum resection
MAP immediately after septum resection
Time frame: immediately after septum resection
HR immediately after septum resection
HR immediately after septum resection
Time frame: immediately after septum resection
MAP before sella bone resection
MAP before sella bone resection
Time frame: before sella bone resection
HR before sella bone resection
HR before sella bone resection
Time frame: before sella bone resection
MAP after sella bone resection
MAP after sella bone resection
Time frame: before sella bone resection
HR immediately after sella bone resection
HR immediately after sella bone resection
Time frame: immediately after sella bone resection
MAP before dural incision of sella
MAP before dural incision of sella
Time frame: before dural incision of sella
HR before dural incision of sella
HR before dural incision of sella
Time frame: before dural incision of sella
MAP immediately after dural incision of sella
MAP immediately after dural incision of sella
Time frame: immediately after dural incision of sella
HR immediately after dural incision of sella
HR immediately after dural incision of sella
Time frame: immediately after dural incision of sella
MAP before exploration of pituitary fossa
MAP before exploration of pituitary fossa
Time frame: before exploration of pituitary fossa
HR before exploration of pituitary fossa
HR before exploration of pituitary fossa
Time frame: before exploration of pituitary fossa
MAP immediately after exploration of pituitary fossa
MAP immediately after exploration of pituitary fossa
Time frame: immediately after exploration of pituitary fossa
HR immediately after exploration of pituitary fossa
HR immediately after exploration of pituitary fossa
Time frame: immediately after exploration of pituitary fossa
numerical rating scale (NRS) score when patient enters post-anaesthesia care unit (PACU) (immediately after surgery)
numerical rating scale (NRS) score when patient enters PACU (immediately after surgery). The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: when patient enters PACU (immediately after surgery)
numerical rating scale (NRS) score before patient leaves PACU
numerical rating scale (NRS) score before patient leaves PACU. The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: before patient leaves PACU
NRS 2 hours after surgery
NRS 2 hours after surgery. The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: 2 hours after surgery
NRS 8 hours after surgery
NRS 8 hours after surgery. The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: 8 hours after surgery
NRS 24 hours after surgery
NRS 24 hours after surgery. The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: 24 hours after surgery
NRS 48 hours after surgery
NRS 48 hours after surgery. The participants subjectively determine the patient's pain scores using a 0 to 10 NRS (0 = no pain; 10 = unbearable pain), to evaluate the efficacy of the modified method.
Time frame: 48 hours after surgery
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quality of recovery Scale: Quality of Recovery-15 (QoR-15) 1 day after surgery
quality of recovery Scale (QoR-15): QoR-15 1 day after surgery. QoR-15 contains the five aspects (physiological comfort, physiological independence, psychological support, emotion and pain), which can evaluate postoperative recovery quality.
Time frame: 1 day after surgery
quality of recovery Scale: QoR-15 3 days after surgery
quality of recovery Scale: QoR-15 3 days after surgery. QoR-15 contains the five aspects (physiological comfort, physiological independence, psychological support, emotion and pain), which can evaluate postoperative recovery quality.
Time frame: 3 days after surgery
quality of recovery Scale: QoR-15 7 days after surgery
quality of recovery Scale: QoR-15 7 days after surgery. QoR-15 contains the five aspects (physiological comfort, physiological independence, psychological support, emotion and pain), which can evaluate postoperative recovery quality.
Time frame: 7 days after surgery