The Effect of Bilateral Infraorbital and Infratrochlear Nerve Block on Perioperative Analgesia After Endoscopic Binostril Transnasal Transsphenoidal Resection of Pituitary: a Prospective, Randomized Study
Overview
- Phase
- Not Applicable
- Intervention
- nerve block with 0.5% ropivacaine
- Conditions
- Pain
- Sponsor
- Tongji Hospital
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- HR before septum resection
- Status
- Active, not recruiting
- Last Updated
- 3 years ago
Overview
Brief Summary
The endoscopic binostril transnasal transsphenoidal resection of pituitary procedures often cause intense pain which is difficult to suppress at the depth of conventional general anesthesia, resulting in severe hemodynamic fluctuations in patients. Infraorbital and infratrochlear nerve block can block the pain signal caused by the endoscopic binostril transnasal transsphenoidal resection of pituitary theoretically, which has been proven to provide satisfactory analgesia after septorhinoplasty. However, whether bilateral infraorbital and infratrochlear nerve block can provide stable hemodynamics and reduce the hemodynamic fluctuation the patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary remains unclear.
Detailed Description
Surgical stimulation is one of the important factors leading to hemodynamic fluctuation and affecting postoperative recovery quality. The endoscopic binostril transnasal transsphenoidal resection of pituitary procedures often cause intense pain because of there were numerous nerve endings at the surgical site which is originated from branches of the trigeminal nerve (including infraorbital and infratrochlear nerve). It's difficult to suppress intraoperative stimulation at the depth of conventional general anesthesia, resulting in severe hemodynamic fluctuations in patients. It's reported that pterygomaxillary fossa block can inhibit hypertension caused by surgical procedures, however the block may cause complications because of its complicated operations. Infraorbital and infratrochlear nerve block can block the pain signal caused by the endoscopic binostril transnasal transsphenoidal resection of pituitary theoretically, which has been proven to provide satisfactory analgesia after septorhinoplasty. However, whether bilateral infraorbital and infratrochlear nerve block can reduce the pain in the patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary remains unclear. Therefore, the investigators propose the hypothesis that preoperative bilateral infraorbital and infratrochlear nerve block could effectively reduce the pain in patients undergoing endoscopic binostril transnasal transsphenoidal resection of pituitary. The objective of this study is to observe the heart rate and blood pressure at a specific point in time during the operation and pain at 2, 8, 24, 48 hours postoperatively between adult patients receiving or not receiving bilateral infraorbital and infratrochlear nerve block.
Investigators
Feng Gao
Professor
Tongji Hospital
Eligibility Criteria
Inclusion Criteria
- •Elective endoscopic binostril transnasal transsphenoidal resection
- •Patients aged between 18 and
- •American Society of Anesthesiologists (ASA) physical status I, Ⅱ and III
Exclusion Criteria
- •Emergency operation.
- •Patients allergic to ropivacaine.
- •Infection nearby the puncture point.
- •Patients with preoperative usage of sedative and analgesic drugs with history of alcohol abuse.
- •Patient with renal insufficiency or hepatic failure.
- •Patients who have undergone craniotomy in the recent 6 months.
- •Pregnant or lactating women, being participating in other studies.
- •Patients unable to cooperate.
Arms & Interventions
Nerve Block Group
Thirty minutes prior to surgery the patients received bilateral infraorbital and infratrochlear nerve block. Infraorbital nerve block was performed while using an extraoral approach. A 25 gauge needle was inserted laterally to the ipsilateral nostril after palpating the infraorbital ridge to locate the infraorbital foramen. The index finger of the non-dominant hand was positioned above the infraorbital foramen, and the needle was advanced until it was felt beneath the finger. 2 mL of the 0.5% ropivacaine slowly injected after negative aspiration of blood was confirmed. Inserting the needle 1 cm above the inner canthus, targeting the junction of the orbit and the nasal bone, performed Infratrochlear nerve block. After negative aspiration of blood, 1 mL of the 0.5% ropivacaine was injected. Contralateral nerve block was performed in the same manner.
Intervention: nerve block with 0.5% ropivacaine
Control Group
Patients receiving general anesthesia without Infraorbital and Infratrochlear nerve block.
Intervention: without any nerve block
Outcomes
Primary Outcomes
HR before septum resection
Time Frame: before septum resection
HR before septum resection
heat rate (HR) before nerve block
Time Frame: before nerve block
heat rate (HR) before nerve block
MAP immediately after nasal mucosal dissection
Time Frame: immediately after nasal mucosal dissection
MAP immediately after nasal mucosal dissection
HR immediately after septum resection
Time Frame: immediately after septum resection
HR immediately after septum resection
MAP before sella bone resection
Time Frame: before sella bone resection
MAP before sella bone resection
HR before exploration of pituitary fossa
Time Frame: before exploration of pituitary fossa
HR before exploration of pituitary fossa
MAP within 10 minutes after nerve block
Time Frame: within 10 minutes after nerve block
MAP within 10 minutes after nerve block
HR within 10 minutes after nerve block
Time Frame: within 10 minutes after nerve block
HR within 10 minutes after nerve block
HR before nasal mucosal dissection
Time Frame: before nasal mucosal dissection
HR before nasal mucosal dissection
HR immediately after nasal mucosal dissection
Time Frame: immediately after nasal mucosal dissection
HR immediately after nasal mucosal dissection
HR immediately after dural incision of sella
Time Frame: immediately after dural incision of sella
HR immediately after dural incision of sella
mean arterial pressure (MAP) before nerve block
Time Frame: before nerve block
mean arterial pressure (MAP) before nerve block
MAP before nasal mucosal dissection
Time Frame: before nasal mucosal dissection
MAP before nasal mucosal dissection
MAP immediately after septum resection
Time Frame: immediately after septum resection
MAP immediately after septum resection
HR before sella bone resection
Time Frame: before sella bone resection
HR before sella bone resection
MAP after sella bone resection
Time Frame: before sella bone resection
MAP after sella bone resection
MAP before dural incision of sella
Time Frame: before dural incision of sella
MAP before dural incision of sella
MAP before exploration of pituitary fossa
Time Frame: before exploration of pituitary fossa
MAP before exploration of pituitary fossa
MAP before septum resection
Time Frame: before septum resection
MAP before septum resection
HR immediately after sella bone resection
Time Frame: immediately after sella bone resection
HR immediately after sella bone resection
HR before dural incision of sella
Time Frame: before dural incision of sella
HR before dural incision of sella
MAP immediately after dural incision of sella
Time Frame: immediately after dural incision of sella
MAP immediately after dural incision of sella
MAP immediately after exploration of pituitary fossa
Time Frame: immediately after exploration of pituitary fossa
MAP immediately after exploration of pituitary fossa
HR immediately after exploration of pituitary fossa
Time Frame: immediately after exploration of pituitary fossa
HR immediately after exploration of pituitary fossa
Secondary Outcomes
- numerical rating scale (NRS) score before patient leaves PACU(before patient leaves PACU)
- NRS 24 hours after surgery(24 hours after surgery)
- NRS 2 hours after surgery(2 hours after surgery)
- NRS 8 hours after surgery(8 hours after surgery)
- quality of recovery Scale: Quality of Recovery-15 (QoR-15) 1 day after surgery(1 day after surgery)
- quality of recovery Scale: QoR-15 3 days after surgery(3 days after surgery)
- NRS 48 hours after surgery(48 hours after surgery)
- numerical rating scale (NRS) score when patient enters post-anaesthesia care unit (PACU) (immediately after surgery)(when patient enters PACU (immediately after surgery))
- quality of recovery Scale: QoR-15 7 days after surgery(7 days after surgery)