Infrazygomatic Versus Intranasal Injection Approaches for Sphenopalatine Ganglion Blockade Effect on The Surgical Field in Functional Endoscopic Sinus Surgeries

Abstract

Background: Functional endoscopic sinus surgery (FESS) is a minimally invasive, efficient surgical procedure frequently utilized for  treating nasal polyposis as well as chronic rhinosinusitis. A clear field is mandatory for surgeons to facilitate the operation; nevertheless,  it is linked to complications such as postoperative pain.

Objectives: We aimed to determine the impact of infrazygomatic approach  sphenopalatine ganglion blockade (SPGB) on hemodynamics, postoperative pain, and the surgical field, in FEES operations.

Patients and  Methods: This a prospective controlled trial, in 35 patients conducted at Ain Shams University Hospitals, Cairo, Egypt, only submucosal  lidocaine was injected after general anesthesia was induced, and one nasal side was randomly selected (left or right) utilizing the closed  envelopes method (intranasal injection group). On the other side, the infrazygomatic sphenopalatine ganglion block technique was done  (the infrazygomatic block group) then surgical field quality, hemodynamic changes, and postoperative complications (infection or  epistaxis) were compared statistically.

Results: The surgical field quality was improved more in the infrazygomatic block side, and mean  heart rate (HR) and arterial blood pressure demonstrated a statistically substantial decline in the infrazygomatic block intraoperatively  but no significant change postoperatively. Additionally, the pain was relieved in the first postoperative 6 hours but statistically no  difference was found between the two groups at 12 and 24 hours postoperatively, and also statistics showed no difference between the  two sides as regards infection or epistaxis.

Conclusion: Infrazygomatic approach of SPGB improves surgical field quality, postoperative  pain, and hemodynamic stability in FEES operation.