Sphenopalatine Ganglion Nerve Block, Transnasal Endoscopic Pitutary Surgery
Conditions
Brief summary
Improving pain and surgical field by using sphenopalatine ganglion block and dexmedetomidine in trans-nasal endoscopic pituitary surgery.
Detailed description
Pituitary neoplasm is one of the most common sellar pathology. Trans-nasal endoscopic pituitary surgery (TEPS) evolved rapidly, almost replacing the craniotomy approach. TEPS, a surgical instrument, is primarily executed through a minimally invasive approach through the nostril to access a pituitary tumor. That is why the anesthetic plan must ensure the best possible surgical field visualization and the most adequate analgesia. Multimodal anesthesia including regional and general anesthesia are obtained to optimize surgical field by decreasing bleeding, reduce pain, promote rapid recovery and potential economic gains for the hospital. The sphenopalatine ganglion block (SPGB) is considered one of the regional anesthetic techniques that is safe and easy anesthetic procedure used to control bleeding and for postoperative analgesia. Dexmedetomidine (DEX) has become popular for induced hypotension. It is an α2-adrenoceptor agonist with a sympatholytic and analgesic effect. It provides a unique conscious sedation without respiratory depression. It is used effectively in optimizing surgical field through its hemodynamic stability effect.
Interventions
PROCEDURESphenopalatine Ganglion Block
patients will receive ultrasound guided bilateral supra-zygomatic sphenopalatine ganglion block.
DRUGDexmedetomidine
patients will receive 1 µg/kg dexmedetomidine within 10 minutes, followed by maintenance dose throughout the surgery.
patients will be operated under general anesthesia including routine protocol for these cases
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
21 Years to 64 Years
Healthy volunteers
No
Inclusion criteria
* Age: between 21-64 years old. * sex: males and females. * Body mass index: 35 kg/m2. * ASA Physical status: grade Ⅰ-Ⅱ.
Exclusion criteria
* patients receiving beta blockers, anti-coagulants and antihypertensive medications also patients receiving clonidine or benzodiazepines, neuroleptics or antidepressants two weeks prior to the study. * Any contraindication for regional anesthesia e.g. coagulopathy, infection at site of block and hypersensitivity to any drug used in this study. * Patients who are known to be drug addict.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain using VAS scale. | 24hours | Pain will be assessed based on VAS scale from (1-10), as 1 is the least pain and 10 is the maximal pain possible at 2, 4, 6, 12 and 24h after surgery. |
| Surgical field using Average Category Scale (ACS). | 5hours | Done by asking the surgeon about amount of bleeding on a scale of (0-5) as 0= no bleeding and 5= sever bleeding, every 15 min interval till the end of surgery. |
Countries
Egypt
Outcome results
None listed