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This study compares ultrasound-guided and Brainlab navigation sphenopalatine ganglion block (SPGB) in functional endoscopic sinus surgery (FESS).
Functional endoscopic sinus surgery (FESS) is the treatment modality of choice for the inflammatory disease of paranasal sinuses.
Sphenopalatine ganglion block (SPGB) is a regional analgesic technique that can be used as an alternative approach to reduce blood loss and improve the operative field during FESS without the need for hypotensive agents.
Ultrasound (US)-guided nerve block is a well-established technique in regional anesthesia and offers the advantage of real-time visualization of neural and vascular structures.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ultrasound group | Experimental | Patients will receive an ultrasound-guided sphenopalatine ganglion block (4 ml bupivacaine 0.25%). |
|
| Brainlab group | Experimental | Patients will receive a Brainlab navigation sphenopalatine ganglion block (4 ml bupivacaine 0.25%). |
|
| Low dose Brainlab group | Experimental | Patients will receive a Brainlab navigation sphenopalatine ganglion block (2 ml bupivacaine 0.25%) (low dose). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-guided sphenopalatine ganglion block | Other | Patients will receive an ultrasound-guided sphenopalatine ganglion block (4 ml bupivacaine 0.25%). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Surgical field condition | The Fromme-Boezaart scale (6-point scale) will be used to assess the endoscopic surgical field condition after GA induction, at the entrance of the endoscope, and after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min. 0=No bleeding (cadaveric conditions).
| 135 min post-procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Mean arterial pressure | Mean arterial pressure will be recorded after induction of general anesthesia, at entrance of endoscope, after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min. | 135 min post-procedure |
| Heart rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Tanta | El-Gharbia | 31527 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Brainlab navigation sphenopalatine ganglion block | Other | Patients will receive a Brainlab navigation sphenopalatine ganglion block (4 ml bupivacaine 0.25%). |
|
| Low dose Brainlab navigation sphenopalatine ganglion block | Other | Patients will receive a Brainlab navigation sphenopalatine ganglion block (2 ml bupivacaine 0.25%) (low dose). |
|
Heart rate will be recorded after induction of general anesthesia, at the entrance of the endoscope, after 15, 30, 45, 60, 75, 90, 105, 120, and 135 min.
| 135 min post-procedure |
| Intraoperative fentanyl consumption | To improve the conditions of the surgical field, hemodynamics will be managed (A fixed target of mean blood pressure around 65 mmHg should be obtained) using these medications in the following order fentanyl 0.5 ug/kg. | Intraoperatively |
| Intraoperative nitroglycerine consumption | Intraoperative requirements of nitroglycerine will be calculated. | Intraoperatively |
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the visual analogue scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS: will be assessed at 0, 4, 8, 12, and 24 h postoperatively | 24 hours postoperatively |
| Time to extubation | Time to extubation: the time from discontinuing anesthesia to fulfilling extubation criteria will be recorded. | One hour postoperatively |
| Recovery time | Recovery time: the time from extubation, till patients attain an Aldrete score >9, will be recorded. | One hour postoperatively |
| Incidence of adverse events | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication | 24 hours postoperatively |