Abstract
BACKGROUND: Regional anesthesia is effective in alleviating postoperative pain and reducing the requirement for systemic pain medications. However, optimal postoperative pain management in endoscopic sinus surgery (ESS) remains challenging. This study investigated the potential pain-reducing outcomes of general anesthesia combined with a bupivacaine injection at the sphenopalatine ganglion (SPG) and an anterior ethmoid nerve block following ESS. METHODS: A double-blind randomized controlled trial that included 80 patients (18-75 years old) with chronic rhinosinusitis who underwent ESS was conducted. Either 0.5% bupivacaine or normal saline was injected into the anterior ethmoid nerve and SPG. The visual analog scale (VAS) pain score was assessed at 0, 1, 2, 4, 6, 8, 12, and 24 h following the surgical procedure. The timing of analgesic administration and any postoperative adverse effects of 0.5% bupivacaine were recorded. RESULTS: The VAS scores were significantly improved in the bupivacaine group at 1 h (95% confidence interval [CI] = 0.77-3.81, p = 0.004), 2 h (95% CI = 1.00-3.47, p = 0.001), 4 h (95% CI = 0.59-2.38, p = 0.002), and 6 h (95% CI = 0.22-2.28, p = 0.0019). Overall, the results showed a significant difference (95% CI = 0.51-1.74, p < 0.001). CONCLUSIONS: Postoperative endoscopic SPG and anterior ethmoid nerve blocks with bupivacaine effectively reduce postoperative pain and minimize analgesic requirements after ESS.