Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery

ABSTRACT Background Research findings are inconsistent regarding the efficiency of regional nasal blocks over hypotensive techniques. The current study aimed to compare regional nasal block to dexmedetomidine (DEX) for surgical field optimization. Methods A total of 70 patients (ASA I or II) aged 18 to 65 years were divided into two groups (35 patients each). The DEX group received 1 µg/kg of DEX in 10 minutes after induction of anesthesia, followed by 0.7 µg/kg/hour during maintenance of anesthesia. The other group [Sphenopalatine ganglion block (SPGB) group] was subjected to regional nasal block by SPGB immediately after induction of general anesthesia. This was done via a transoral approach using 2 ml of a mixture of lidocaine (2%) and bupivacaine (0.5%) for each side. Results Surgical conditions were satisfactory in all patients of both groups, but significantly better with bilateral SPGB. In addition, the block group had also improved extubation characteristics and postoperative analgesia. Patients who received bilateral SPGB complained significantly of dental numbness. Conclusions Both DEX and regional nasal block provided excellent functional endoscopic sinus surgery (FESS) with a high score of surgeons’ satisfaction. The SPGB can provide better surgical field optimization with less blood loss, less intraoperative analgesic consumption, and early extubation with minor complications, and better immediate postoperative pain profile. So, SPGB can be used efficiently and safely in combination with general anesthesia in patients undergoing FESS.