Efficacy of Ultrasound-Guided Bilateral Suprazygomatic Maxillary Nerve Block with Levobupivacaine for Perioperative Analgesia in Functional Endoscopic Sinus Surgery and Septoplasty: A Randomized, Double-Blind, Placebo-Controlled Trial
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Keywords
maxillary nerve block, suprazygomatic approach, functional endoscopic sinus surgery, septoplasty, levobupivacaine
Abstract
Background: Functional endoscopic sinus surgery (FESS) and septoplasty cause substantial perioperative pain owing to rich innervation of the nasal structures by the maxillary division (V2) of the trigeminal nerve. The ultrasound-guided suprazygomatic maxillary nerve block (SMB) targets V2 within the pterygopalatine fossa for focused, opioid-sparing analgesia. Objective: To compare bilateral SMB using 0.125% levobupivacaine with saline placebo for perioperative analgesia, intraoperative haemodynamics, opioid sparing, and satisfaction. Methods: In this prospective, randomized, double-blind, placebo-controlled trial, 60 patients (ASA I–II, 15–60 years) were randomized equally to Group SMB (0.125% levobupivacaine 5 mL per side) or Group Control (0.9% saline 5 mL per side) after induction. Outcomes were visual analogue scale (VAS) pain scores, time to first rescue analgesia, 24-hour rescue use, intraoperative heart rate (HR) and mean arterial pressure (MAP), satisfaction, and adverse events. Results: Group SMB had lower VAS at every timepoint (0 hr, 0.2 ± 0.3 vs 1.3 ± 0.79; 24 hr, 1.4 ± 0.5 vs 3.6 ± 0.94; nasal pack removal, 1.1 ± 0.5 vs 4.9 ± 1.3; all P<0.001). Rescue analgesia was delayed (22.7 ± 1.39 vs 6.1 ± 3.8 hr) and doses fewer (0.5 ± 0.5 vs 2.7 ± 2.0; both P<0.001). Intraoperative HR and MAP were lower in Group SMB after intubation (P<0.001). Patient and surgeon satisfaction were higher (median 5 vs 2 and 5 vs 3; P<0.001). No adverse events occurred. Conclusion: Bilateral ultrasound-guided SMB with 0.125% levobupivacaine improved perioperative analgesia, including during nasal pack removal, reduced rescue analgesia, attenuated intraoperative haemodynamic responses, and improved satisfaction, without adverse events.
Keywords: maxillary nerve block; suprazygomatic approach; functional endoscopic sinus surgery; septoplasty; levobupivacaine.
References
2. Grape S, Kirkham KR, Frauenknecht J, Albrecht E. Intra- and post-operative analgesia with regional versus systemic techniques for functional endoscopic sinus surgery: a systematic review with meta-analysis. Anaesthesia 2019;74(9):1202–10.
3. Picard V, Augris-Mathieu C, Delbos A. Suprazygomatic maxillary nerve block for perioperative analgesia in pediatric cleft palate surgery. Paediatr Anaesth 2011;21(1):91–5.
4. Chiono J, Bernard N, Bringuier S, et al. The suprazygomatic maxillary nerve block for perioperative analgesia in children and adults: a prospective multicentre randomized double-blind placebo-controlled study. Reg Anesth Pain Med 2014;39(1):42–7.
5. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000;59(3):551–79.
6. Neupane A, Jain D, Arora S, et al. Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: a randomized controlled trial. Indian J Anaesth 2024;68(8):706–11. doi:10.4103/ija.ija_81_24.
7. Yılmaz N, Çilingir B. The effects of maxillary nerve block in septoplasty. J Perianesth Nurs 2025;S1089-9472(25)00048-6. doi:10.1016/j.jopan.2025.02.010.
8. Afandy ME, Abd Elghafar MS, Shoukr TG, El Mourad MB. Efficacy of ultrasound-guided suprazygomatic maxillary nerve block on emergence agitation and postoperative analgesia after septorhinoplasty: a prospective randomized trial. J Anaesthesiol Clin Pharmacol 2024;40(4):679–85.
9. Çelik M, Tulgar S, Picard V, Thomas DT. High-volume injection of local anaesthetic at the suprazygomatic approach for maxillary nerve block: analysis via CBCT images. J Clin Anesth 2020;60:102–3.
10. Huang IY, Chen CM, Chuang FH, Chen CM. The pterygopalatine fossa injection: a literature review. J Oral Maxillofac Surg 2010;68(11):2728–35.
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