The maxillary nerve block is a regional anesthetic technique targeting the sensory distribution of the maxillary nerve and is particularly preferred to provide analgesia in midfacial and maxillary surgical procedures. It has been used to optimize perioperative and postoperative pain control, reduce intraoperative opioid requirements, and support hemodynamic stability in procedures including septorhinoplasty, nasal bone osteotomies, nasal valve surgery, and endoscopic sinus surgery. This study aimed to compare the effects of the timing of bilateral maxillary nerve block administration (post-intubation vs. pre-extubation) on intraoperative remifentanil consumption and postoperative analgesia in patients undergoing septorhinoplasty.
18 to 65 years old
American Society of Anesthesiologists (ASA) physical status I-II
Body mass index 18 to 30 kg/m2
Septorhinoplasty surgery
Patient refusing the procedure
Patients who have previously undergone nasal surgery
Chronic opioid or analgesic use
Patients with allergies to local anesthetics
Parallel
Preoperative Maxillary Block
DrugAfter the intubation, the block procedure will be performed under ultrasound guidance using an infrazygomatic approach to access the pterygopalatine fossa. Prior to the procedure, the cheek region will be prepared in accordance with aseptic conditions. A linear ultrasound probe will be positioned over the infrazygomatic area to visualize the maxillary tuberosity, lateral pterygoid plate, coronoid process, and mandibular condyle. The following image optimization using the jaw-opening maneuver, the maxillary artery will be identified as an anatomical landmark, and a 50-mm block needle will be advanced into the pterygopalatine fossa using an in-plane technique. After confirmation of negative aspiration, a total of 4 mL of local anesthetic solution consisting of 2 mL of 0.5% bupivacaine and 2 mL of 2% lidocaine (Aritmal) will be injected on each side. The same procedure will subsequently be repeated contralaterally.
Postoperative Maxillary Block
DrugAt the end of the surgery, before the extubation, the block procedure will be performed under ultrasound guidance using an infrazygomatic approach to access the pterygopalatine fossa. Prior to the procedure, the cheek region will be prepared in accordance with aseptic conditions. A linear ultrasound probe will be positioned over the infrazygomatic area to visualize the maxillary tuberosity, lateral pterygoid plate, coronoid process, and mandibular condyle. The following image optimization using the jaw-opening maneuver, the maxillary artery will be identified as an anatomical landmark, and a 50-mm block needle will be advanced into the pterygopalatine fossa using an in-plane technique. After confirmation of negative aspiration, a total of 4 mL of local anesthetic solution consisting of 2 mL of 0.5% bupivacaine and 2 mL of 2% lidocaine (Aritmal) will be injected on each side. The same procedure will subsequently be repeated contralaterally.
Intraoperative remifentanil consumption
The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded.
Mean arterial pressure
Mean arterial pressure values will be recorded before anesthesia, before surgical incision, after surgical incision at the 5th, 30th, 60th, 90th, 120th, 150th, 180th, and 210th minutes, and after general anesthesia.
Heart rate
Heart rate values will be recorded before anesthesia, before surgical incision, after surgical incision at the 5th, 30th, 60th, 90th, 120th, 150th, 180th, and 210th minutes, and after general anesthesia.
Pain scores
Pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 10 (worst pain). Pain assessment will be done at the 1st, 2nd, 6th, 12th, and 24th hours after surgery.
Click on the lead sponsor to view all of their trials.
Atatürk Chest Diseases and Chest Surgery Training and Research Hospital
Lead sponsor
Ankara Etlik City Hospital
Sponsor institution
