Effectiveness of pre-emptive nerve block on opioid consumption in patients undergoing nasal surgeries under general anesthesia - A Double Blinded Randomized Controlled Study

Nasal surgeries done under general anaesthesia produces mild to moderate postoperative pain. However these surgeries can still produce unexpectedly high levels of postoperative pain. In addition to perioperative pain, the performance of nasal surgery under general anaesthesia alone is an independent risk factor for emergence agitation which may lead to serious complications such as hypoxia, aspiration, bleeding or reoperation. Facial nerve blocks are described for nasal surgeries, but their use as sole anaesthetic technique for nasal procedures with prolonged duration and risk of bleeding is limited. Among these described nerve blocks, nasociliary and maxillary nerves forms the major contributing nerve supply of nose, nasal mucosa, septum and nasal cavity. Therefore, blocking of these nerves provide superior pain relief without clinically significant side effects for nasal surgeries. However, the benefits of these nerve blocks when combined with general anaesthesia, if any, on intraoperative opioids consumption and postoperative recovery outcomes in  nasal surgeries with longer duration and risk of bleeding have not been previously studied. Thus, we designed this study to test the primary hypothesis that the addition of bilateral maxillary and nasociliary nerve blocks to a standardized general anaesthetic decreases the intraoperative opioids consumption following nasal surgery. We also sought to determine the effect of bilateral maxillary and nasociliary nerve blocks on the emergence and recovery characteristics.