Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial

Abstract

Background & objective: The benefits of sphenopalatine ganglion (SPG) block during endoscopic septoplasty are yet unclear due to a lack of adequate data. We investigated the efficacy of SPG block (SPGB) with lidocaine versus bupivacaine for minimizing intraoperative bleeding and providing a bloodless surgical field in patients having endoscopic septoplasty under general anesthesia. Methodology: In this double-blind, randomized controlled trial, 60 patients with ASA I and II were scheduled for endoscopic septoplasty. Following standard general anesthesia, patients were randomly assigned to one of three groups. Group C (n = 20): SPGB was performed using normal saline in the control group; Group L (n = 20); patients received SPGB with 2% lidocaine, and Group B (n = 20); patients received SPGB with 0.5% bupivacaine. Intraoperative blood loss, surgical field quality, postoperative pain-free duration, postoperative analgesic requirements, and the patient satisfaction were recorded. The collected data were verified, coded by the researcher, and analyzed using the Statistical Package for Social Sciences (IBM-SPSS/PC/VER 21). Statistical analysis was done with the Shapiro-Wilk test, one-way ANOVA test and two-way repeated measure ANOVA test as required. The Kaplan–Meier curve was plotted to explore the differences in the post-operative pain-free durations among the studied groups using the log-rank test. A p-value less than 0.05 was considered significant. Results: The intraoperative blood loss and surgical field grading were lower in the groups treated with lidocaine (44.9 ± 3.7 ml, P < 0.001) or bupivacaine (41.4 ± 2.9 ml, P < 0.001) in comparison to the control group (89.95 ± 7.8 ml). There was no difference between the two groups. Postoperative meperidine requirement in 24 h was higher in the control group (36.25 ± 2.9 mg) than the lidocaine group (18.75 ± 2.5 mg; P < 0.001) and the bupivacaine group (16.25 ± 2.7 mg; P < 0.001). Conclusion: Sphenopalatine ganglion blockade with bupivacaine or lidocaine decreased intraoperative blood loss and improved surgical field visibility compared to placebo during endoscopic septoplasty under general anesthesia. There were statistically no significant differences in sphenopalatine ganglion blocks with either lidocaine or bupivacaine. Abbreviations: SPG- Sphenopalatine Ganglion; SPGB- Sphenopalatine Ganglion Block; VAS- Visual Analog Scale Keywords: Bupivacaine; Endoscopic Septoplasty; Lidocaine; Postoperative Analgesia; Sphenopalatine Ganglion Block Citation: Ghazaly HF, Khalefa MM, Sedeek MA, Hasanen MK. Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial. Anaesth. pain intensive care 2024;28(1):92-99; DOI: 10.35975/apic.v28i1.2393 Received: August 29, 2023; Reviewed: December 29, 2023; Accepted: December 31, 2023