Ultrasound Guided Glossopharyngeal and Maxillary Nerve Blocks for Perioperative Pain Control in Adenotonsillectomy in Pediatrics: A Randomized Controlled Trial.

Patients will be premedicated with oral midazolam 0.5 mg/kg prior to arriving in the operating room 30 min before the procedure.

Standard monitoring will be maintained throughout the procedure included electrocardiography, noninvasive arterial pressure, arterial oxygen saturation.

. If intravenous access is present, Fentanyl 1 μg/kg IV will be given and anesthesia will be induced using propofol 2-3 mg/kg and atracurium 0.5 mg/kg. If intravenous access is not present, anesthesia will be induced with inhalation of 8% sevoflurane in 100% oxygen under spontaneous ventilation and IV access will be established, fentanyl 1 µg/kg IV and atracurium 0.5 m g/kg IV will be given after achieving IV access. Endotracheal intubation will be done using an appropriate size endotracheal tube (ETT) and capnography attached. IV dexamethasone 150 μg/kg will be given. Anesthesia will be maintained using a 50:50 mixture of air and oxygen along with isoflurane 1.2% and the maintenance dose of atracurium 0.1 mg/kg each 20 minutes. Pressure-controlled ventilation and low fresh gas flows will be used. All patients will receive intraoperative analgesia in the form of single dose paracetamol 15 mg/kg.

Patients will be randomly allocated into two equal groups:

Block Group: patients will receive combined bilateral ultrasound-guided glossopharyngeal nerve (UGGNB) and bilateral ultrasound-guided maxillary nerve (UGMNB) immediately after the induction of anesthesia and prior to surgical incision by an expert anesthesiologist in ultrasound guided regional anesthesia who is not a part of the study using Philips Model HD5 Diagnostic ultrasound system a the scanning probe will be the linear ultrasound probe (4-12MHz) for glossopharyngeal nerve block and a curvilinear ultrasound probe (5-7 MHz) for maxillary nerve block using fine needle as described with aid of ultrasound.