Sphenopalatine Ganglion Block in Maxillofacial Surgeries
Condition: Postoperative Pain
MeSH terms: Ganglion Cysts
Study type: Interventional

Summary: 
      Patients will be divided into 2 groups, 30 each. Group A will receive sphenopalatine ganglion
      block via a gauze soaked in local anesthetic introduced in the 2 nostrils then by local
      anesthetic injected by a cannula into both nostrils. Group B will undergo the same procedure,
      but normal saline will be used instead of the local anesthetic.
    

Detailed description: 
      The local anesthetic mixture will be prepared using a 1:1 combination of xylocaine 2% and
      bupivacaine 0.5% in a 10 mL syringe. On admission to the operating room (OR) blood pressure,
      heart rate, and oxygen saturation at room air will be recorded.

      The patient will then lie supine with slight neck extension, with nostrils pointing upwards.

      Group A patients will have the cotton swab soaked in the local anesthetic (LA) medication
      introduced into their nostrils along the superior edge of the middle concha to the posterior
      wall of the nasopharynx to receive approximately 0.5ml of the medication. Then the
      investigators will inject 1.5 ml of medication via a syringe connected to a 20 gauge (G)
      catheter into their nostrils bilaterally.

      Group B patients will undergo the same procedure but the cotton swab will be soaked into a
      normal saline solution, and the injection will also be done with normal saline.

      After 5 minutes a standard anesthetic technique will be followed. After preoxygenation for
      three minutes, anesthesia will be induced with propofol 2 mg/kg, fentanyl 2 µg/kg, and
      atracurium besylate 0.5 mg/kg will provide muscle relaxation. The patient will be monitored
      using the 4 standard general anesthesia monitors; pulse oximeter, capnogram, non-invasive
      blood pressure (NIBP), and the 5 lead ECG for the whole operation, in addition to the bi
      spectral index (BIS) till the end of the surgery, extubation, and transfer to the
      post-anesthesia care unit (PACU).

      Patient blood pressure and heart rate will be monitored throughout the whole operation and
      after the operation in the PACU.

      The patient's postoperative pain will be assessed by the visual analog scale (VAS) score from
      0 = (no pain) to 10 = (worst pain).

      Intraoperative bleeding will be estimated using the gauze visual analog. The time to the
      first analgesic request was recorded. It was defined as the time from recovery until VAS
      score greater than 4.

      During the study, the following data will be recorded:

      Demographic data & patients' characteristics (age, body weight, body mass index (BMI) Type of
      surgery (Maxillary, mandibular, or combined)

      Intraoperative hemodynamics: Mean blood pressure and heart rate were recorded at the
      following timings:

      T0: preoperatively as a baseline T1: After intubation T2: After skin incision T-end: At skin
      closure Postoperatively: In the PACU Intraoperative mean anesthetic concentration (MAC) is
      measured every 30 minutes till the end of surgery.

      Total intraoperative fentanyl consumption in micrograms, where the patient will receive
      additional doses of fentanyl (1ug/kg) when mean arterial pressure (MAP)> 100 The duration of
      surgery (time from skin incision till the end of skin closure) Recovery time in minutes (time
      interval between discontinuation of isoflurane and extubation.) VAS every 4 hours
      postoperatively till 12 hours.
    

Intervention name(s): Sphenopalatine ganglion block using bupivacaine: xylocaine; Sphenopalatine ganglion block using normal saline
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients will have the cotton swab soaked in the LA medication introduced into their nostrils along the superior edge of the middle concha to the posterior wall of the nasopharynx to receive approximately 0.5ml of the medication, and then they will have 1.5 ml of the medication injected via a syringe connected to a 20 G catheter into their nostrils bilaterally.; Patients will have the cotton swab soaked in normal saline introduced into their nostrils along the superior edge of the middle concha to the posterior wall of the nasopharynx to receive approximately 0.5ml of the medication, and then they will have 1.5 ml normal saline injected via a syringe connected to a 20G catheter into their nostrils bilaterally.
Intervention MeSH terms: Lidocaine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Sphenopalatine ganglion block; Blood loss; Pain