Neupane Adhip, Jain Divya, Arora Suman, Gandhi Komal, Singla Varun, Goel Nitika, Virk Ramandeep Singh, Mohindra Satyawati
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Otorhinolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Anaesth. 2024 Aug;68(8):706-711. doi: 10.4103/ija.ija_81_24. Epub 2024 Jul 2.
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.
术后疼痛会妨碍功能性鼻内镜鼻窦手术（FESS）后的功能恢复并延迟出院。本研究旨在评估超声（USG）引导下颧上颌神经阻滞（SZMNB）对FESS术后疼痛的疗效。
本随机对照研究纳入了48例年龄在18至65岁之间、美国麻醉医师协会身体状况分级为I级和II级且计划接受FESS的成年患者。患者被随机分配接受USG引导下的SZMNB联合全身麻醉（n = 24）或单纯全身麻醉（n = 24）。术后即刻的数字评分量表（NRS）疼痛评分被记录为主要结局。术后24小时的总补救性镇痛药物消耗量、外科医生满意度评分、术后血流动力学和术后并发症被记录为次要结局。
阻滞组术后即刻NRS疼痛评分的中位数（四分位间距）为0（0 - 0.25）[95%置信区间（CI）：0，0.08]，而对照组为2（1.75 - 3）[95% CI：1.60，2.40]，P < 0.001]。直到术后24小时，所有时间间隔的疼痛评分均显著降低（P < 0.001）。阻滞组没有患者需要补救性镇痛。相比之下，对照组有8例患者在术后1小时内需要静脉注射75毫克双氯芬酸作为补救性镇痛，10例患者在术后1 - 6小时内需要。两组间的其他次要结局具有可比性（P > 0.05）。
USG引导下的SZMNB为接受FESS的患者提供了良好的术后镇痛效果，且无明显副作用。
