title: Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery.
abstract: BACKGROUND
  Endoscopic sinus surgery (ESS) is a common procedure preferably done with an anesthetic technique ensuring effective postoperative analgesia while speeding discharge home. Although anesthesia administered locally in conjunction with vasoconstricting agents is  known to minimize intraoperative bleeding, its usefulness in providing postoperative analgesia has not been well characterized. The results supporting the use of regional anesthesia for sinus surgery have also been limited. Using a randomized, double-blinded and placebo-controlled design,  we evaluated recovery times, opioid consumption, and nausea and vomiting after ESS when patients were randomized to either general anesthesia (GA) alone or with regional blockade.
  
  
  METHODS
  Subjects were 70 adults scheduled for sinus surgery. All participants underwent propofol/remifentanil/nitrous  oxide anesthesia and similar intraoperative care. Patients received either GA alone or with sphenopalatine ganglion (SPG) blocks in a double-masked study design. Independent observers recorded readiness for discharge, incidence of nausea/vomiting, and pain scores every 15 minutes until discharge.  Overall opioid use in the recovery area was also a secondary end point. Twenty-four hours later, patients were called and asked to rate their pain and overall satisfaction with their pain control.
  
  
  RESULTS
  Block group participants were considered ready for discharge after  45 minutes and discharged from the hospital ∼40 minutes sooner than GA group participants. The block group required less total fentanyl in the recovery room than did the GA group. The incidences of nausea and vomiting did not differ significantly. Data at 24 hours postoperatively did not  differ significantly between groups but trended toward increased satisfaction in the block group. No lasting adverse events were observed.
  
  
  CONCLUSIONS
  Regional anesthesia using targeted nerve blocks is effective in ESS. The combination of GA and SPG blockade appears to  shorten hospital stay and reduce narcotic requirements in the recovery area. No demonstrable benefits were observed after 24 hours regarding pain management.
authors.affiliation: Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. samuel.demaria@mountsinai.org
authors.forename: Samuel
authors.initials: S
authors.lastname: DeMaria
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.forename: Nina
authors.initials: N
authors.lastname: Chinosorvatana
authors.forename: Stanley
authors.initials: S
authors.lastname: Kang
authors.forename: Adam I
authors.initials: AI
authors.lastname: Levine
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods; D004724:Endoscopy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000517:prevention & control; D010256:Paranasal Sinuses / Q000601:surgery*; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control; D059387:Sphenopalatine Ganglion Block
chemical_list: D005283:Fentanyl