Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial

• Published in: Indian journal of anaesthesia Vol. 68; no. 8; pp. 706 - 711
• Main Authors: Neupane, Adhip, Jain, Divya, Arora, Suman, Gandhi, Komal, Singla, Varun, Goel, Nitika, Virk, Ramandeep Singh, Mohindra, Satyawati
• Format: Journal Article
• Language: English
• Published: India Medknow Publications & Media Pvt. Ltd 01-08-2024; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Analgesics; Clinical outcomes; Endoscopy; functional endoscopic sinus surgery; General anesthesia; nerve blocks; numerical rating scale; Original; Otolaryngology; Pain; postoperative pain; Postoperative period; regional nerve block; suprazygomatic maxillary nerve block; Surgery; Ultrasonic imaging; ultrasound; suprazygomatic maxillary nerve block; nerve blocks; numerical rating scale; postoperative pain; Functional endoscopic sinus surgery; regional nerve block; ultrasound
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.ija_81_24

Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS.
Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes.
The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group,
< 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (
< 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1-6 h of surgery in the control group. Other secondary outcomes were comparable between groups (
> 0.05).
The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.