Patients undergoing endoscopic surgeries for pituitary adenoma excision suffer from wide swings in blood pressure that might increase bleeding and interfere with the surgical field. Local anethetic infiltration and regional nerve blocks have been used to provide better analgesia, control blood pressure and improve surgical field. Limited studies evaluated shenopalatine ganglion block in pituitary adenoma excision with promising outcomes. The proposed study will compare the efficacy of two local anesthetics, prilocaine and lidocaine, for spenopalatine ganglion block in patients undergoing endoscopic pituitary adenoma excision. Evaluating the control of the intraoperative blood pressure and analgesic sparing are the main objectives of the proposed study.
Pituitary adenoma excision through endoscopic sinus surgery has been evolving over the years. Though less traumatic less traumatic and less invasive than other approaches, hemodynamic variations during several phases of the surgey as nasal dissection pose challenges for anesthesiologists. Regional techniques present appealing options for better control of blood pressure during periods of maximal surgical stimulation, they may as well provide a better surgical field. One of the regional techniques is the sphenopalatine ganglion bock where a local anesthetic is injected in the pterygopalatine fossa around the sphenopalatine ganglion. Thus, It blocks pain transmission through the branches of the trigeminal nerve. The current study was designed to compare the effects of two local anesthetics, lidocaine versus prilocaine on intraoperative hemodynamics, surgical field and analgesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
54
Sphenopalatine ganlion block with 2ml of 2% lidocaine and 0.5ml of diluted adrenaline after general anesthesia in patients undergoing enoscopic hypophysectomy.
Sphenopalatine ganlion block with will receive 2ml of 4% prilocaine and 0.5ml saline after general anesthesia in patients undergoing enoscopic hypophysectomy.
Sphenopalatine ganlion block with will receive 2ml of 4% prilocaine in addition to 0.5ml of diluted adrenaline. after general anesthesia in patients undergoing enoscopic hypophysectomy.
Kasr El Ainy
Cairo, Egypt
RECRUITINGMAP
mean arterial blood pressure in the intraoperative period 5 minutes after nasal dissection
Time frame: Mean arterial blood pressure in mmhg in the intraoperative period 5 minutes after nasal dissection
MAP
mean arterial blood presssure 5 minutes after nasal dissection
Time frame: Mean arterial blood pressure in mmhg after 5 minutes of nasal dissection
Mean arterial blood pressure
Mean arterial blood pressure in mmhg before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Time frame: Before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Systolic blood pressure
Systolic blood pressure before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Time frame: Systolic blood pressure in mmhg before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Diastolic blood preesure
Diastolic blood pressure before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Time frame: Diastolic blood pressure in mmhg before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
HR
Heart rate before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Time frame: Heart rate in beats/min before induction of Anesthesia, Before the block, 15 minutes after the block, 5 min of nasal dissection and every 30 minutes till the end of operation.
Patients needing propranolol
The number of patients needing propranolol in each group.
Time frame: The number of patients throughout the study in the intraoperative period who received propranolol
Propranolol needed
The total amount of propranolol in mg used in each group
Time frame: The amount of propranolol in mg used throughout the surgery in each group
Patients needing phentolamine
The number of patients needing phentolamine in each group.
Time frame: The number of patients receiving phentolamine throughout the surgery in both groups
Phentolamine needed
The total amount of phentolamine in mg used in each group.
Time frame: Throughout the surgical time from the begining to the end of surgery
Surgeon satisfaction scale
Surgeon satisfaction scale based on Average category scale (ACS) from 0 to 5 with 0 meaning no bleeding and 5 massive uncontrollable bleeding
Time frame: 10 minutes after the end of surgery.
Time to 1st analgesic requirement
The time from emergence of anaesthesia till the request of first rescue analgesia
Time frame: The time in hours from emergence of anaesthesia till the request of first rescue analgesia in the first 24 hours after surgery
Blood loss
The total ammount of blood loss in cc
Time frame: Throughout the surgical time from the begining to the end of surgery
Requirement for transfusion
The number of patients requiring transfusion
Time frame: Throughout the surgical time from the begining to the end of surgery
Fentanyl needed
number of patients needing fentanyl boluses intraoperatively
Time frame: Throughout the surgical time from the begining to the end of surgery
Total amount of fentanyl
total ammount of fentanyl needed in micrograms
Time frame: Throughout the surgical time from the begining to the end of surgery
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