Effects of Sphenopalatine Ganglion Nerve Block on Bleeding and Pain During and After Septorhinoplasty: A Systemic Review and Meta-analysis.

Background: Administration of a sphenopalatine ganglion block using a local anesthetic has been proposed as a method to reduce bleeding and pain associated with septorhinoplasty, but definitive evidence to support this practice is lacking.

Methods: Relevant studies were identified through systematic searches of PubMed, SCOPUS, Google Scholar, Embase, and the Cochrane Register of Controlled Trials. Five studies were included in the meta-analysis. In all of them, the outcomes of patients receiving perioperative SPGB (treatment group) were compared with those of patients receiving either a placebo or no intervention (control group). The primary outcomes in the present study were pain and bleeding, with quantitative data synthesized using standardized mean differences.

Results: Patients in the SPGB group had significantly less intraoperative pain, as evidenced by less remifentanil consumption, and required fewer postoperative analgesics than the control group. Postoperative pain scores were consistently lower in the SPGB group for up to 24 h. Mean arterial pressure during surgery was also better controlled in the treatment group. The quality of the surgical field was improved, as indicated by reduced bleeding and higher surgeon satisfaction. However, no differences emerged between groups in terms of operative time or lower or upper eyelid ecchymosis.

Conclusion: The results of this meta-analysis support the use of SPGB with local anesthesia in septorhinoplasty to significantly reduce intraoperative and postoperative complications, particularly in terms of managing pain and bleeding.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.