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The primary aim of this study is to compare the effect of bilateral US guided percutaneous PPFB versus transnasal approach on intraoperative anaesthetic requirements (guided by entropy) in patients undergoing endoscopic transsphenoidal resection of pituitary gland surgery in conjucation with general anaesthesia (GA).Secondary aims: total dose of intraoperative dexmedetomidine, intraoperative analgesia (fentanyl), haemodynamics, the surgical field conditions, recovery pattern, and side effects
Endoscopic endonasal transsphenoidal resection of pituitary gland is the currently most used method for the resection of pituitary tumors. It is a minimally invasive surgical technique to access sellar and parasellar lesions.
The main goal in endoscopic pituitary surgery are minimal tissue manipulation and clear bloodless field with better panoramic visualization under haemodynamic stability and good postoperative analgesia to improve the outcome .pterygopalatine fossa block (PPFB) is used to maintain haemodynamic stability and to decrease intraoperative anaesthetic requirements (PPFB)can be done transnasal or percutaneous ultrasound guided
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bilateral trans-nasal pterygopalatine Fossa block | Active Comparator | using 4ml 0.25% bupivacaine after the induction of GA. |
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| Bilateral US-guided infrazygomatic percutaneous pterygopalatine Fossa block | Active Comparator | using 4ml 0.25% bupivacaine after the induction of GA |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| trans-nasal pterygopalatine Fossa block | Other | Patients will be placed in 15-degree reverse Trendelenburg position, between the middle and inferior turbinates. This passage will be sterilized by an cotton-tipped applicator soaked with iodine solution. A 20-gauge/5-inch spinal needle will be used after bending 2-3 mm of its tip along the port side with a sterile needle holder to form a 45 angle. The needle will be lubricated with 5% lidocaine jelly, inserted into the nasal meatus and advanced with the bevel pointer facing laterally. Under endoscopic control (0_ optics, 4 mm diameter), the needle will be inserted between middle and inferior turbinate. A total of 4 ml 0.25% bupivacaine will be injected after negative aspiration just behind and over middle turbinate tail, where the pterygopalatine fossa is deeply located. |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative anaesthetic requirements (guided by entropy) in patients undergoing endoscopic transsphenoidal resection of pituitary adenoma in conjucation with general anaesthesia (GA). | The primary aim of this study is to compare the effect of bilateral US guided percutaneous PPFB versus transnasal approach on intraoperative anaesthetic requirements (guided by entropy) in patients undergoing endoscopic transsphenoidal resection of pituitary gland surgery in conjucation with general anaesthesia (GA). | recorded after 15 minutes from the induction of anaesthesia, then every 15 minutes till the end of the surgery. Total volume of anaesthetic agent will be measured at the end of the surgery (millimeter /minutes). |
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Inclusion Criteria:
Exclusion Criteria:
Patients will be excluded if; .History of allergy or contraindication to any of the studied drugs.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kafrelsheikh University | Kafr ash Shaykh | 23023 | Egypt | |||
| Kafrelsheikh University |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41622136 | Derived | Saad DH, Ahmed AMM, ElKholy WM, Bakr MM. Ultrasound-guided percutaneous versus trans-nasal pterygopalatine fossa block in endoscopic trans-sphenoidal pituitary gland surgery: a randomized controlled trial. BMC Anesthesiol. 2026 Feb 2;26(1):139. doi: 10.1186/s12871-026-03618-0. |
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| US-guided infrazygomatic percutaneous pterygopalatine Fossa block | Other | US- guided percutaneous PPFB: Patients will be placed in the lateral head position; the patient's mouth is slightly opened. Following standard sterile preparations, US linear probe covered with sterile sheath is positioned horizontally on the side of the face just below the zygomatic bone superior to the mandibular notch and anterior to the mandibular condyle to visualize the coronoid process, the lateral pterygoid muscle, the lateral pterygoid plate, and the maxillary bone, and the maxillary artery. Needle will be inserted in-plane parallel to the transducer probe and advanced from medial to lateral toward the pterygopalatine fossa. Following negative aspiration, the injectate is deposited deep to the lateral pterygoid muscle and plate. A total of 4 ml 0.25% bupivacaine will be injected. |
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| Kafr ash Shaykh |
| Egypt |