European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 1, pp 165–169 | Cite as

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

  • Elvin Kesimci
  • Levent ÖztürkEmail author
  • Sami Bercin
  • Muzaffer Kırış
  • Ayşe Eldem
  • Orhan Kanbak


The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.


Regional anesthesia General anesthesia Nerve block Endoscopic sinus surgery 


Conflict of interest

The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.


  1. 1.
    Slack R, Bates G (1998) Functional endoscopic sinus surgery. Am Fam Physician 58:707–718PubMedGoogle Scholar
  2. 2.
    Yang JJ, Li WY, Jil Q et al (2005) Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine-containing solutions of lidocaine produces profound hypotension. Acta Anaesthesiol Scand 49:1471–1476PubMedCrossRefGoogle Scholar
  3. 3.
    Hadzic A, Arliss J, Kerimoglu B, Rosenquist R, Santos AC, Thys DM et al (2004) A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology 101:127–132PubMedCrossRefGoogle Scholar
  4. 4.
    Cumberworth VL, Sudderick RM, Mackay IS (1994) Major complications of functional endoscopic sinus surgery. Clin Otolaryngol Allied Sci 19:248–253PubMedCrossRefGoogle Scholar
  5. 5.
    Friedman M, Venkatesan TK, Lang D, Caldarelli DD (1996) Bupivacaine for postoperative analgesia following endoscopic sinus surgery. Laryngoscope 106:1382–1385PubMedCrossRefGoogle Scholar
  6. 6.
    Keleş GT, Topçu I, Ekici Z, Yentür A (2010) Evaluation of piroxicam-beta-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery. Braz J Med Biol Res 43:806–811PubMedGoogle Scholar
  7. 7.
    Junger A, Klasen J, Benson M et al (2001) Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol 18:314–321PubMedGoogle Scholar
  8. 8.
    Wennervirta J, Hynynen M, Koivusalo AM, Uutela K, Huiku M, Vakkuri A (2008) Surgical stres index as a measure of nociception/antinociception balance during general anesthesia. Acta Anaesthesiol Scand 52:1038–1045PubMedCrossRefGoogle Scholar
  9. 9.
    Hwang JH, Liu CM, Liu TC, Hsu MC (2003) Sphenopalatine ganglion block before removal of nasal packing. Laryngoscope 113:1423–1424PubMedCrossRefGoogle Scholar
  10. 10.
    Higashizawa T, Koga Y (2001) Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. J Anesth 15:136–138PubMedCrossRefGoogle Scholar
  11. 11.
    May M, Levine HL, Mester SJ, Schaitkin B (1994) Complications of endoscopic sinus surgery: analysis of 2108 patients—incidence and prevention. Laryngoscope 104:1080–1083PubMedGoogle Scholar
  12. 12.
    Janzen VD, Scudds R (1997) Sphenopalatine block in the treatment of pain in fibromyalgia and myofascial pain syndrome. Laryngoscope 107:1420–1422PubMedCrossRefGoogle Scholar
  13. 13.
    Westreich R, Sampson I, Shaari CM, Lawson W (2006) Negative-pressure pulmonary edema after routine septorhinoplasty: discussion of pathophysiology, treatment, and prevention. Arch Facial Plast Surg 8:8–15PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Elvin Kesimci
    • 1
  • Levent Öztürk
    • 1
    Email author
  • Sami Bercin
    • 2
  • Muzaffer Kırış
    • 2
  • Ayşe Eldem
    • 1
  • Orhan Kanbak
    • 1
  1. 1.Department of Anesthesiology and ReanimationAnkara Atatürk Training and Research HospitalAnkaraTurkey
  2. 2.Department of Ear Nose and Throat (ENT) SurgeryAtaturk Training and Research HospitalAnkaraTurkey

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