Sphenopalatine Ganglion Block in Endoscopic Sinus Surgery: A Comparative Study

Abstract

Objectives: The aim of this study was to find the effect of sphenopalatine ganglion block given via greater palatine foramen in managing intraoperative bleeding, postoperative pain and its effect on functional outcome and postoperative adverse effects in Functional Endoscopic Sinus Surgery (FESS). Methods: In this prospective study, a total of 60 consenting patients posted for FESS for chronic sinusitis were selected and randomised into two groups. Group A received sphenopalatine ganglion block via greater palatine foramen and group B did not. Intraoperative surgical field visibility was measured by Average Category Scale by Fromm and Boezaart. Postoperatively those with pain score more than 4 in VAS were given diclofenac injection. Functional outcome was measured by SNOT 22. Results: There was no significant difference in age and sex distribution of patients in both groups. Preoperative SNOT scores were comparable in both groups. There was improvement noted in surgical field in block group compared to non- block group. Significantly lesser requirement of postoperative analgesics was noted in this study with p value <.01. Postoperatively functional outcome with SNOT22 scores significantly improved in both groups compared to preoperative SNOT 22 scores. Better improvement was seen in block (A) group. Mean postoperative SNOT22 score in group B (14.3) was significantly higher than that in group A (5.2). Number of adverse effects reported in both groups was comparable. Conclusion: Intraoperative bleeding which reduces surgical field visibility and postoperative pain which results in excessive use of analgesics are common problems faced by endoscopic sinus surgeons. In this study, addition of sphenopalatine ganglion block to general anesthesia was tried in FESS to overcome these problems and to improve the outcome. This study showed a significantly reduced need for postoperative analgesics with use of SPG block. Patients who received SPG block showed better improvement in functional outcome and comparable occurrence of adverse effects with the no block recipients. Even though there was improvement in surgical field in SPG block group, we couldn’t establish a statistically significant outcome.