Kim Do Hyun, Jang David W, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
Aesthetic Plast Surg. 2025 Sep 29. doi: 10.1007/s00266-025-05279-9.
Administration of a sphenopalatine ganglion block using a local anesthetic has been proposed as a method to reduce bleeding and pain associated with septorhinoplasty, but definitive evidence to support this practice is lacking.
Relevant studies were identified through systematic searches of PubMed, SCOPUS, Google Scholar, Embase, and the Cochrane Register of Controlled Trials. Five studies were included in the meta-analysis. In all of them, the outcomes of patients receiving perioperative SPGB (treatment group) were compared with those of patients receiving either a placebo or no intervention (control group). The primary outcomes in the present study were pain and bleeding, with quantitative data synthesized using standardized mean differences.
Patients in the SPGB group had significantly less intraoperative pain, as evidenced by less remifentanil consumption, and required fewer postoperative analgesics than the control group. Postoperative pain scores were consistently lower in the SPGB group for up to 24 h. Mean arterial pressure during surgery was also better controlled in the treatment group. The quality of the surgical field was improved, as indicated by reduced bleeding and higher surgeon satisfaction. However, no differences emerged between groups in terms of operative time or lower or upper eyelid ecchymosis.
The results of this meta-analysis support the use of SPGB with local anesthesia in septorhinoplasty to significantly reduce intraoperative and postoperative complications, particularly in terms of managing pain and bleeding.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
使用局部麻醉剂进行蝶腭神经节阻滞已被提议作为一种减少鼻中隔成形术相关出血和疼痛的方法，但缺乏支持这种做法的确切证据。
通过对PubMed、SCOPUS、谷歌学术、Embase和Cochrane对照试验注册库进行系统检索，确定相关研究。五项研究纳入荟萃分析。在所有研究中，将接受围手术期蝶腭神经节阻滞的患者（治疗组）的结果与接受安慰剂或无干预的患者（对照组）的结果进行比较。本研究的主要结局是疼痛和出血，使用标准化均数差值对定量数据进行综合分析。
蝶腭神经节阻滞组患者术中疼痛明显减轻，表现为瑞芬太尼用量减少，且术后所需镇痛药物比对照组少。蝶腭神经节阻滞组术后疼痛评分在长达24小时内持续较低。治疗组手术期间的平均动脉压也得到更好的控制。手术视野质量得到改善，表现为出血减少和外科医生满意度提高。然而，两组在手术时间或上下眼睑瘀斑方面没有差异。
这项荟萃分析的结果支持在鼻中隔成形术中使用局部麻醉的蝶腭神经节阻滞，以显著减少术中和术后并发症，特别是在控制疼痛和出血方面。
证据级别III：本刊要求作者为每篇文章指定证据级别。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266。
