The Effect of Sphenopalatine Block on the Postoperative Pain of Endoscopic Sinus Surgery: A Meta-analysis

Abstract

Objectives: The use of sphenopalatine ganglion block (SPGB) with a local anesthetic to decrease postoperative pain after endoscopic sinus surgery (ESS) is controversial. We investigated the role of a perioperative SPB to minimize postoperative pain related to ESS in patients with chronic sinusitis through a systematic review of the relevant literature.

Data sources: PubMed, SCOPUS, Google Scholar, Embase, and the Cochrane Register of Controlled Trials.

Review methods: We screened the relevant literature published before June 2018. Eight articles that compared perioperative SPGB (treatment group) with a placebo or no treatment (control group) were included for this analysis of the outcomes, which included perioperative morbidities in ESS. For quantitative variables, the standardized mean difference was applied to standardize and summate the results of the studies, and the odds ratio was used in outcome of incidence analysis.

Results: Intraoperative bleeding ( P < .0001), postoperative pain ( P = .0001), nausea and vomiting ( P = .0117), and recovery from sedation ( P < .0001) in the treatment group were significantly reduced compared with the control group. No significant adverse effects were reported in the enrolled studies. In subgroup analyses according to the SPGB approach (transoral or transnasal), the transnasal approach showed higher positive effects on intraoperative bleeding and postoperative pain compared to the transoral approach.

Conclusion: In our study, SPGB combined with a local anesthetic for ESS effectively reduced intra-and postoperative morbidities. This procedure showed no significant adverse effects. Given the ease and effectiveness of this procedure, the transnasal approach should be highly recommended as a routine procedure compared to the transoral approach.

Keywords: adverse effect; bleeding; endoscopic sinus surgery; meta-analysis; postoperative pain; sphenopalatine ganglion block.