Preemptive application of US-guided suprazygomatic maxillary nerve block may lower emergence agitation, suggests study

Emergence agitation (EA) refers to the manifestation of aggressive psychomotor symptoms during the emergence from general anesthesia, and it can lead to harm for both the patient and medical staff. It is commonly observed following nasal surgeries, and postoperative pain is considered a significant factor contributing to this condition. Therefore, effective pain management plays a crucial role in preventing EA in such surgical procedures. The use of preemptive analgesia through peripheral nerve blocks in conjunction with general anesthesia offers the benefit of maintaining a stable hemodynamic profile, promoting good recovery quality, and reducing the need for both intra- and postoperative analgesics. The maxillary nerve (MN) is a purely sensory nerve responsible for transmitting sensation from various facial structures, such as the nasal cavity, nose, palate, dental arch, cheek, lip, sinus, and eyelid. Consequently, blocking this nerve can effectively provide pain relief for diverse procedures, including septoplasty and endoscopic sinus surgery.

Recent research paper evaluated the effectiveness of a suprazygomatic maxillary nerve (MN) block guided by ultrasound (US) in reducing emergence agitation (EA) and improving postoperative analgesia for patients undergoing septorhinoplasty. The study was a prospective randomized trial that compared outcomes between a group that received the nerve block (SMB group) and a control group that did not. The key findings were: 1. Incidence of EA was significantly lower in the SMB group (16.7%) compared to the control group (46.6%, p=0.026). 2. Pain scores at 30 minutes and 1, 2, 4, and 6 hours postoperatively were significantly decreased in the SMB group compared to the control group (p=0.024, 0.000, 0.000, 0.009, and 0.038 respectively). 3. Total 24-hour postoperative morphine consumption was significantly less in the SMB group compared to the control group (p=0.000). 4. Intraoperative consumption of fentanyl and isoflurane was also significantly reduced in the SMB group compared to the control group (p=0.000 and p=0.001 respectively). The researchers concluded that preemptive application of US-guided suprazygomatic MN block was effective in lowering the incidence of EA and enhancing postoperative analgesia in patients undergoing septorhinoplasty. The regional nerve block reduced the requirement for intraoperative anesthetic agents and postoperative rescue analgesics. No serious adverse events were reported. Overall, the findings suggest that the MN block is a valuable technique for improving postoperative outcomes in this patient population.

Key Points

Here are the 6 key points from the research paper:

1. The study evaluated the effectiveness of a suprazygomatic maxillary nerve (MN) block guided by ultrasound (US) in reducing emergence agitation (EA) and improving postoperative analgesia for patients undergoing septorhinoplasty.

2. The incidence of EA was significantly lower in the SMB group (16.7%) compared to the control group (46.6%, p=0.026).

3. Pain scores at 30 minutes and 1, 2, 4, and 6 hours postoperatively were significantly decreased in the SMB group compared to the control group.

4. Total 24-hour postoperative morphine consumption was significantly less in the SMB group compared to the control group (p=0.000).

5. Intraoperative consumption of fentanyl and isoflurane was also significantly reduced in the SMB group compared to the control group.

6. The researchers concluded that preemptive application of US-guided suprazygomatic MN block was effective in lowering the incidence of EA and enhancing postoperative analgesia, and reduced the requirement for intraoperative anesthetic agents and postoperative rescue analgesics, with no serious adverse events reported.

Reference –

Afandy ME, Abd Elghafar MS, Shoukr TG, El Mourad MB. Efficacy of ultrasound‑guided suprazygomatic maxillary nerve block on emergence agitation and postoperative analgesia after septorhinoplasty: A prospective randomized trial. J Anaesthesiol Clin Pharmacol 2024. DOI: 10.4103/joacp.joacp_256_23.