Perioperative outcome of ultrasound-guided pterygopalatine fossa block in functional endoscopic sinus surgery: A randomized controlled trial

Abstract

ABSTRACTBackground Ultrasound (US)-guided pterygopalatine fossa (PPF) block helps to improve the field of surgery and control hemodynamic fluctuations during functional endoscopic sinus surgery (FESS).Patients and methods 120 eligible patients (60 per group) members of the American Society of Anesthesiologists class I or II aged 18 to 50 were randomly classified by closed envelope method. Group C: Patients in the control group received only general anesthesia (GA). Group PFB: Patients received bilateral PPF block with 4 ml 0.25% bupivacaine after induction of GA.Results Heart rate (HR) was significantly lower in PFB than in the control group at 15 min after induction of GA to 105 min intraoperatively. Between the two groups, there was no statistically significant difference in mean arterial blood pressure (MABP). Fentanyl and propranolol were less significantly used intraoperatively in the PFB group. Nitroglycerine was not needed in the PFB group while ten patients in group C received it. The total intraoperative isoflurane consumption and the mean consumption per minute used intraoperatively were significantly higher in the control group. There was a significant statistical difference between the two groups at 15 min only where the endoscopic surgical field condition in group PFB was more visible than in group C. The mean time to extubation and recovery time in group C was significantly longer than in group PFB.Conclusion US-guided PPF block controls the hemodynamics and improves surgical field conditions during FESS, reduces perioperative anesthetics consumption, and enhances good recovery patterns.

Keywords

• FESS
• hemodynamics
• bloodless field
• ultrasound
• pterygopalatine ganglion