This study aims to evaluate the efficacy of ultrasound guided sphenopalatine ganglion block (SPGB) through the suprazygomatic approach in optimizing the quality of surgical field as well as its effect on postoperative pain relief in patients undergoing transsphenoidal pituitary surgeries under general anesthesia.
Age between 21 and 60 years.
American Society of Anesthesiologists (ASA) Physical Status I or II.
Undergoing elective endoscopic trans-nasal resection of pituitary adenoma.
Patient's refusal
ASA Physical Status III or IV patients
Patients receiving drugs influencing blood coagulation
Allergy to any of the drugs utilized in this study
Parallel
Sphenopalatine ganglion block using bupivacaine + dexamethasone
DrugPatients will receive sphenopalatine ganglion block (SPGB) using 4 mL of 0.25% bupivacaine combined with 1 mL of dexamethasone.
General anesthesia
Other interventionPatients will receive general anesthesia alone.
Quality of surgical field visibility
Quality of surgical field visibility will be measured at the beginning of surgery and at 30 mins interval through a pre-defined average category scale (ACS) (from 0 to 5). The ideal category scale values for surgical conditions were pre-determined to be ≤3. 0=No bleeding 1. Slight bleeding - no suctioning of blood required 2. Slight bleeding - occasional suctioning required. Surgical field not threatened 3. Slight bleeding - frequent suctioning required. Bleeding threatens surgical field a few seconds after suction is removed 4. Moderate bleeding - frequent suctioning required. Bleeding threatens surgical field directly after suction is removed 5. Severe bleeding - constant suctioning required. Bleeding appears faster than can be removed by suction. Surgical field severely threatened and surgery not possible
Intraoperative fentanyl consumption
The hemodynamic objective of the anesthetic plan is to maintain mean arterial pressure values between 60 mmHg and 65 mmHg to produce an optimal surgical field, this will be done by injection of increments of fentanyl (0.5 μg/kg) up to total dose of 3 μg/kg
Total dose of propranolol
In case of reflex persistent increase in heart rate (HR) \>100 beats/min, i.v. 0.2 mg increments of propranolol will be given to maintain HR 60-70 beats/min.
Total dose of nitroglycerine
In case of reduction of mean arterial pressure (MAP), nitroglycerine infusion will be done through adjustment from 0.5 to 10 μg/kg/ min according to patient response.
Amount of intraoperative blood loss
Amount of intraoperative blood loss (by measuring the volume of blood in suction reservoir minus the normal saline used to wash the surgical field)
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