Skip to main content Skip to main navigation menu Skip to site footer

Analysis of the effectiveness of sphenopalatine ganglion block on fentanyl needs in endoscopic endonasal surgery as measured by qNOX score

  • Agil Rumboko Sumitro ,
  • Agustina Salinding ,
  • Dedi Susila ,
  • Budi Sutikno ,


Abstract

Introduction: Endoscopic endonasal is one of the technological advances used as a supporting examination for diagnosis and therapy. This procedure is often used to evaluate medical problems of the nose and sinuses, such as functional endoscopic sinus surgery or FESS (functional endoscopic sinus surgery), turbinoplasty, and septoplasty. Surgery can be difficult to manage because there is often bleeding due to the large supply of blood vessels in the sinus area. This study aimed to investigate differences in qNOX scores and fentanyl requirement in patients undergoing endoscopic endonasal surgery with sphenopalatine ganglion block.

Methods: The total sample was 18 patients, with each treatment 9 patients. Patients were divided into two groups: group 1 patients who received sphenopalatine ganglion block with 0.75% ropivacaine and group 2 patients who did not receive a block. The selection of patients in groups 1 or 2 was done randomly (simple random) using lottery numbers and with a single blind.

Result: Statistical analysis showed significant differences in intraoperatively in qNOX scores at the 5th, 10th, 15th and 20th minute and the mean qNOX score in the first 1 hour between the control group and the sphenopalatine ganglion block group. Significant differences were also found in fentanyl requirement between the control group and intraoperative sphenopalatine ganglion block, where fentanyl requirement was lower in the treatment group.

Conclusion: The sphenopalatine ganglion block is a useful adjunct in patients undergoing endoscopic surgery and may reduce the need for fentanyl. In addition, it can provide a more stable qNOX score

Keywords: Endoscopic endonasal Fentanyl Sphenopalatine ganglion block qNOX

References

  1. Govindaraj, S., Adappa, N. D., dan Kennedy, D. W. (2010). Endoscopic sinus surgery: Evolution and technical innovations. Journal of Laryngology and Otology, 124(3), 242-250. doi:10.1017/S0022215109991368
  2. Saxena Amit, Nekhendzy V. (2020). Anesthetic considerations for functional endoscopic sinus surgery: a narrative review. Journal of Head & Neck Anesthesia 4:e25. doi: 10.1097/HN9.0000000000000025
  3. Ubale, Pravin Virappa. (2015). Anesthetic considerations in functional endoscopic sinus surgery. Otorhinolaryngology Clinics, 7(1), 22-27. doi:10.5005/jp-journals-10003-1182
  4. Sethi, Sameer, Mahesh, Prabhu Vishal, Malhotra, S. K., Maitra, Souvik, dan Gupta, Ashok K. (2017). Comparison ropivacaine and bupivacaine in sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery: A randomized controlled trial. Acta Anaesthesiologica Belgica, 68(3), 137-142
  5. Ismail, Salah A., dan Anwar, Hisham M. F. (2005). Bilateral Sphenopalatine Ganglion block in Functional Endoscopic Sinus Surgery under General Anaesthesia. Alexandria Journal of Anaesthesia and Intensive Care AJAIC, 8(8)
  6. Brunton LL. (2018). Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th ed. San Diego. McGraw-Hill. P 934-945
  7. Melia, Umberto., Gabarron, Eva.,Agustí, Mercé., Souto, et.al. (2017). Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery. Journal of Clinical Monitoring and Computing, 31(6), 1273-1281. doi:10.1007/s10877-016-9948-z
  8. Jensen, E. W., Valencia, J. F., López, A., Anglada, T., Agustí, M., Ramos, Y., Gambus, P. (2014). Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia. Acta Anaesthesiologica Scandinavica, 58(8), 933-941. doi:10.1111/aas.12359
  9. Ali, Ashgan R., Sakr, Sameh A., dan Rahman, Ahmed Shawky M. A. (2010). Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during endoscopic trans-nasal resection of pituitary adenoma. Egyptian Journal of Anaesthesia, 26(4), 273-280. doi:10.1016/j.egja.2010.05.002
  10. Flood P, Rathmell JP, Shafer S. (2015). Stoelting’s pharmacology and physiology in Anesthetic practice, 5th ed. Philadelphia. Wolters Kluwer Health. P 765-776
  11. Ismail, Salah A., dan Anwar, Hisham M. F. (2005). Bilateral Sphenopalatine Ganglion block in Functional Endoscopic Sinus Surgery under General Anaesthesia. Alexandria Journal of Anaesthesia and Intensive Care AJAIC, 8(8)
  12. Kumar Abhijit, Sarada Sreenath, dan Nibha Kumar. (2020). Sphenopalatine Ganglion Block in Endoscopic Sinus Surgery: A Comparative Study. J Allergy Ther, Vol.11 Iss.2 No:297
  13. Pedersen, Juri L., Crawford, Michael E., Dahl, Joørgen B., Brennum, Jannick, dan Kehlet, Henrik. (1996). Effect of preemptive nerve block on inflammation and hyperalgesia after human thermal injury. In (Vol. 84, pp. 1020-1026).
  14. Nemergut, Edward C., Dumont, Aaron S., Barry, Usha T., dan Laws, Edward R. (2005). Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesthesia and Analgesia, 101(4), 1170-1181. doi:10.1213/01.ane.0000166976.61650.ae
  15. Candido, Kenneth D., Massey, Scott T., Sauer, Ruben, Darabad, Raheleh Rahimi, dan Knezevic, Nebojsa Nick. (2013). A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician, 16(6). doi:10.36076/ppj.2013/16/e769
  16. Ahmed, Md Hassan M., dan Abu-Zaid, Md Ehab H. (2007). Role of Intraoperative Endoscopic Sphenopalatine Ganglion Block in Sinonasal Surgery. Journal of Medical Sciences, 7(8), 1297-1303. doi:10.3923/jms.2007.1297.1303
  17. Al-Qudah, Mohannad. (2016). Endoscopic sphenopalatine ganglion blockade efficacy in pain control after endoscopic sinus surgery. International Forum of Allergy and Rhinology, 6(3), 334-338. doi:10.1002/alr.21644
  18. Yang, Ian Y., dan Oraee, Saeed. (2006). A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician, 9(2), 131-134
  19. Felisati, Giovanni, Arnone, Flavio, Lozza, Paolo, Leone, Massimo, Curone, Marcella, dan Bussone, Gennaro. (2006). Sphenopalatine endoscopic ganglion block: A revision of a traditional technique for cluster headache. Laryngoscope, 116(8), 1447-1450. doi:10.1097/01.mlg.0000227997.48020.44

How to Cite

Sumitro, A. R., Salinding, A., Susila, D. ., & Sutikno, B. . (2022). Analysis of the effectiveness of sphenopalatine ganglion block on fentanyl needs in endoscopic endonasal surgery as measured by qNOX score. Bali Medical Journal, 11(3), 1582–1586. https://doi.org/10.15562/bmj.v11i3.3869
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
0

Share

Search Panel

Agil Rumboko Sumitro
Google Scholar
Pubmed
BMJ Journal

Agustina Salinding
Google Scholar
Pubmed
BMJ Journal

Dedi Susila
Google Scholar
Pubmed
BMJ Journal

Budi Sutikno
Google Scholar
Pubmed
BMJ Journal