This study compares ultrasound-guided and Brainlab navigation sphenopalatine ganglion block (SPGB) in functional endoscopic sinus surgery (FESS).
Functional endoscopic sinus surgery (FESS) is the treatment modality of choice for the inflammatory disease of paranasal sinuses. Sphenopalatine ganglion block (SPGB) is a regional analgesic technique that can be used as an alternative approach to reduce blood loss and improve the operative field during FESS without the need for hypotensive agents. Ultrasound (US)-guided nerve block is a well-established technique in regional anesthesia and offers the advantage of real-time visualization of neural and vascular structures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Patients will receive an ultrasound-guided sphenopalatine ganglion block (4 ml bupivacaine 0.25%).
Patients will receive a Brainlab navigation sphenopalatine ganglion block (4 ml bupivacaine 0.25%).
Patients will receive a Brainlab navigation sphenopalatine ganglion block (2 ml bupivacaine 0.25%) (low dose).
Tanta University
Tanta, El-Gharbia, Egypt
Surgical field condition
The Fromme-Boezaart scale (6-point scale) will be used to assess the endoscopic surgical field condition after GA induction, at the entrance of the endoscope, and after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min. 0=No bleeding (cadaveric conditions). 1. Slight bleeding, no suctioning required. 2. Slight bleeding, occasional suctioning required. 3. Slight bleeding, frequent suctioning required; bleeding threatens the surgical field a few seconds after suction is removed. 4. Moderate bleeding, frequent suctioning required, and bleeding threatens the surgical field directly after suction is removed. 5. Severe bleeding, constant suctioning required; bleeding appears faster than can be removed by suction; surgical field severely threatened, and surgery usually not possible.
Time frame: 135 min post-procedure
Mean arterial pressure
Mean arterial pressure will be recorded after induction of general anesthesia, at entrance of endoscope, after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min.
Time frame: 135 min post-procedure
Heart rate
Heart rate will be recorded after induction of general anesthesia, at the entrance of the endoscope, after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min.
Time frame: 135 min post-procedure
Intraoperative fentanyl consumption
To improve the conditions of the surgical field, hemodynamics will be managed (A fixed target of mean blood pressure around 65 mmHg should be obtained) using these medications in the following order fentanyl 0.5 ug/kg.
Time frame: Intraoperatively
Intraoperative nitroglycerine consumption
Intraoperative requirements of nitroglycerine will be calculated.
Time frame: Intraoperatively
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Degree of pain
Each patient will be instructed about postoperative pain assessment with the visual analogue scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS: will be assessed at 0, 4, 8, 12, and 24 h postoperatively
Time frame: 24 hours postoperatively
Time to extubation
Time to extubation: the time from discontinuing anesthesia to fulfilling extubation criteria will be recorded.
Time frame: One hour postoperatively
Recovery time
Recovery time: the time from extubation, till patients attain an Aldrete score \>9, will be recorded.
Time frame: One hour postoperatively
Incidence of adverse events
Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication
Time frame: 24 hours postoperatively