Ultrasound-Guided Suprazygomatic Maxillary Nerve Block effective for Postoperative Pain in Functional Endoscopic Sinus Surgery: Study

FESS is presently the conventional surgical approach for managing sinonasal pathologies. Recent randomized controlled trial aimed to assess the efficacy of ultrasound-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain management in patients undergoing functional endoscopic sinus surgery (FESS). The study enrolled 48 adult patients aged 18-65 years with ASA physical status I-II who were scheduled for FESS. Patients were randomly allocated to receive either SZMNB with general anesthesia (GA) (n=24) or GA alone (n=24).

Study Outcomes

The primary outcome was the numerical rating scale (NRS) pain score in the immediate postoperative period. Secondary outcomes included 24-hour postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative hemodynamics, and postoperative complications.

Postoperative Pain Scores

The median (IQR) NRS pain score in the immediate postoperative period was significantly lower in the SZMNB group compared to the control group \[0 (0-0.25) vs 2 (1.75-3), p<0.001\]. Pain scores were also significantly reduced at all time points up to 24 hours after surgery in the SZMNB group compared to control (p<0.001).

Rescue Analgesia

None of the patients in the SZMNB group required rescue analgesia, whereas 8 patients in the control group required intravenous diclofenac within 1 hour of surgery and 10 patients within 1-6 hours. The time taken to perform the SZMNB block was 485 (SD 26.0) seconds. Successful spread of the local anesthetic was confirmed in 37 out of 40 blocks, and the maxillary artery was visualized in 35 out of 40 blocks.

Postoperative Parameters

Postoperative heart rate was significantly lower in the SZMNB group compared to control up to 2 hours after surgery (p<0.05), but mean arterial pressure was similar between groups. There was no significant difference in surgeon satisfaction scores or incidence of postoperative complications between groups.

Conclusion

In conclusion, the ultrasound-guided SZMNB provided excellent postoperative analgesia for patients undergoing FESS without significant side effects. This regional nerve block technique can be effectively utilized to improve postoperative pain management in patients undergoing FESS.

Key Points

Here are the 6 key points from the research paper: 1. The study was a randomized controlled trial that aimed to assess the efficacy of ultrasound-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain management in patients undergoing functional endoscopic sinus surgery (FESS). 2. The primary outcome was the numerical rating scale (NRS) pain score in the immediate postoperative period, while secondary outcomes included 24-hour postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative hemodynamics, and postoperative complications. 3. The median NRS pain score in the immediate postoperative period was significantly lower in the SZMNB group compared to the control group, and pain scores were also significantly reduced at all time points up to 24 hours after surgery in the SZMNB group. 4. None of the patients in the SZMNB group required rescue analgesia, whereas 8 patients in the control group required intravenous diclofenac within 1 hour of surgery and 10 patients within 1-6 hours. 5. Postoperative heart rate was significantly lower in the SZMNB group compared to the control group up to 2 hours after surgery, but mean arterial pressure was similar between groups. There was no significant difference in surgeon satisfaction scores or incidence of postoperative complications between groups. 6. The ultrasound-guided SZMNB provided excellent postoperative analgesia for patients undergoing FESS without significant side effects, and this regional nerve block technique can be effectively utilized to improve postoperative pain management in patients undergoing FESS.

Reference –

Neupane A, Jain D, Arora S, Gandhi K, Singla V, Goel N, et al. Evaluation of ultrasound‑guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial. Indian J Anaesth 2024;68:706‑11