Yahia Abdelrahman Bakr Albadry Sara Hossam El-din Taha Saleh Amr Mohamed El-said John Nader Naseef

Keywords: Bupivacaine, Endoscopic Sinus Surgery, Fentanyl, Sphenopalatine Ganglion Block

Abstract

Background & objective: Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical technique used in some nasal conditions, refractory to medical treatment, for example chronic rhinosinusitis. The pain after the procedure is usually addressed with non-steroidal anti-inflammatory drugs (NDAIDs) or opioids, which are not without side effects. We conducted this study to assess the effect of bilateral sphenopalatine ganglion block with 0.5% bupivacaine injection at the end of the surgery in controlling postoperative pain.

Methodology: We performed a double blinded randomized clinical trial on 70 patients undergoing FESS under general anesthesia. Sample size was calculated using PASS software version 15. Based on the findings of a previous study, using a two-sided two- sample equal-variance t-test with the population effect size at 0.7, the significance level (alpha) at 0.05 and the power (1- β) at 0.8, a sample size of at least 70 patients (35 per group) was produced. The patients were randomly assigned to one of the two groups; a control group, where normal saline was injected in the greater palatine foramen transorally, and the study group (SPG block group), where 0.5% bupivacaine was injected. Pain was then assessed postoperatively by the visual analogue scale (VAS); and the time to first need of inj. fentanyl as rescue analgesia and the total amount used were recorded.

Results: Maximum intensity of the pain was at 2 hours post-operatively in the control group and 6 hours in the SPG block group, and pain intensity was lower in the SPG block group at 2, 6 and 12 hours post- operatively. In the SPG block group, less patients required rescue analgesia, time needed for the first dose of rescue analgesia was more, and the total 24-hour fentanyl consumption was lower.

Conclusions: Sphenopalatine ganglion block using 0.5% bupivacaine results in better postoperative pain management, and a reduced need for analgesics in patients undergoing functional endoscopic sinus surgery.

Keywords: Bupivacaine; Endoscopic Sinus Surgery; Fentanyl; Sphenopalatine Ganglion Block

Citation: Albadry YAB, Saleh SHET, El-said AM, Naseef JN. The effect of sphenopalatine ganglion block with 0.5% bupivacaine on postoperative pain after functional endoscopic sinus surgery (FESS) under general anesthesia. Anaesth. pain intensive care 2025;29(4):356-62. DOI: 10.35975/apic.v29i4.2820

Received: April 02, 2025; Revised: June 06/ June 12, 2025; Accepted: June 12, 2025