Assistant Lecturer in Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Asyut, Egypt.
Professor in Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Asyut, Egypt.
Anaesth Crit Care Pain Med. 2024 Dec;43(6):101429. doi: 10.1016/j.accpm.2024.101429. Epub 2024 Oct 2.
Nasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA.
This study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption.
This double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side.
A significant decrease in the incidence of EA was found in G1 compared to G2 (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h vs. 3 h).
SPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery.
National Clinical Trial Registry, NCT04168879.
鼻科手术在全身麻醉苏醒过程中报告有很高的躁动发生率。苏醒躁动（EA）会增加手术部位出血、从手术台上摔下、导管和静脉输液管被移除以及自行拔管的风险。本研究探讨了神经阻滞在 EA 中的作用。
本研究评估了超声引导蝶腭神经节阻滞（SPGB）对鼻内镜鼻窦手术后 EA 的影响。主要结果是 EA 的发生率。次要结果包括手术野质量、出血量、吸入麻醉、MAC、PACU 中的 VAS、术后镇痛持续时间以及总 24 小时阿片类药物消耗量。
这是一项双盲、随机对照研究，共纳入 120 例患者，其中 110 例完成了研究。他们被随机分为两组：G1 组接受全身麻醉和双侧蝶腭神经节阻滞（SPGB），每侧 5mL 2%利多卡因，G2 组（对照组）接受全身麻醉和双侧蝶腭神经节盐水注射，每侧 5mL。
与 G2 组相比，G1 组 EA 的发生率显著降低（20% vs. 64%）。G1 组术中出血量明显减少，手术野质量明显提高。G1 组在 PACU 中的疼痛严重程度明显低于 G2 组，24 小时术后阿片类药物消耗量明显减少。此外，G1 组术后镇痛持续时间明显长于 G2 组（9 小时 vs. 3 小时）。
SPGB 可有效降低鼻内镜鼻窦手术后 EA 的发生率、严重程度和持续时间。此外，SPGB 可减少术中出血，改善手术野质量，延长术后镇痛时间，并减少鼻内镜鼻窦手术后 24 小时阿片类药物的消耗。
国家临床试验注册中心，NCT04168879。
