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Published in: European Archives of Oto-Rhino-Laryngology 8/2021

01-08-2021 | Sinus Surgery | Review Article

The efficacy of sphenopalatine ganglion block for pain management after endoscopic sinus surgery: a meta-analysis of randomized controlled studies

Author: Ping Wang

Published in: European Archives of Oto-Rhino-Laryngology | Issue 8/2021

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Abstract

Introduction

The efficacy of sphenopalatine ganglion (SPG) block for pain control after endoscopic sinus surgery remains controversial. We conduct a systematic review and meta-analysis to explore the influence of SPG block on pain intensity after endoscopic sinus surgery.

Methods

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2019 for randomized controlled trials (RCTs) assessing the efficacy of SPG block for pain management after endoscopic sinus surgery. This meta-analysis is performed using the random-effect model.

Results

Six RCTs are included in the meta-analysis. Overall, compared with control group for endoscopic sinus surgery, SPG block is associated with the decrease in pain scores at 6 h (Std. MD =  − 0.71; 95% CI =  − 1.08 to − 0.34; P = 0.0002) and 24 h (Std. MD =  − 0.51; 95% CI =  − 0.87 to − 0.14; P = 0.006), the number of rescue analgesics (RR = 0.26; 95% CI = 0.16 to 0.42; P < 0.00001) and incidence of nausea and vomiting (RR = 0.52; 95% CI = 0.30–0.89; P = 0.02), but demonstrate no obvious impact on pain scores at 2 h (Std. MD =  − 0.99; 95% CI =  − 2.80–0.83; P = 0.29) or headache (RR = 1.30; 95% CI = 0.38–4.46; P = 0.67).

Conclusions

SPG block can provide additional benefits for pain management after endoscopic sinus surgery.
Literature
1.
go back to reference DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL (2017) Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope 127:550–555CrossRef DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL (2017) Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope 127:550–555CrossRef
2.
go back to reference Boonmak P, Boonmak S, Laopaiboon M (2016) Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS). Cochrane Database Syst Rev 10:8 Boonmak P, Boonmak S, Laopaiboon M (2016) Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS). Cochrane Database Syst Rev 10:8
3.
go back to reference Citardi MJ, Agbetoba A, Bigcas JL, Luong A (2016) Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study. Internat Forum Allergy Rhinol 1:523–528CrossRef Citardi MJ, Agbetoba A, Bigcas JL, Luong A (2016) Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study. Internat Forum Allergy Rhinol 1:523–528CrossRef
4.
go back to reference Pletcher SD (2017) Rethinking pain management in endoscopic sinus surgery. JAMA Otolaryngol Head Neck Surg 143:794–795CrossRef Pletcher SD (2017) Rethinking pain management in endoscopic sinus surgery. JAMA Otolaryngol Head Neck Surg 143:794–795CrossRef
5.
go back to reference Khanwalkar AR, Shen J, Kern RC, Welch KC, Smith SS, Tan BK et al (2019) Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery. Internat Forum Allergy Rhinol 2:345–351CrossRef Khanwalkar AR, Shen J, Kern RC, Welch KC, Smith SS, Tan BK et al (2019) Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery. Internat Forum Allergy Rhinol 2:345–351CrossRef
6.
go back to reference Finkensieper M, Poller K, Wittekindt C, Meissner W, Guntinas-Lichius O (2013) Postoperative pain assessment after functional endoscopic sinus surgery (FESS) for chronic pansinusitis. Eur Arch Otorhinolaryngol 270:157–166CrossRef Finkensieper M, Poller K, Wittekindt C, Meissner W, Guntinas-Lichius O (2013) Postoperative pain assessment after functional endoscopic sinus surgery (FESS) for chronic pansinusitis. Eur Arch Otorhinolaryngol 270:157–166CrossRef
7.
go back to reference Al-Qudah M, Rashdan Y (2010) Role of dexamethasone in reducing pain after endoscopic sinus surgery in adults: a double-blind prospective randomized trial. Ann Otol Rhinol Laryngol 119:266–269CrossRef Al-Qudah M, Rashdan Y (2010) Role of dexamethasone in reducing pain after endoscopic sinus surgery in adults: a double-blind prospective randomized trial. Ann Otol Rhinol Laryngol 119:266–269CrossRef
8.
go back to reference Svider PF, Nguyen B, Yuhan B, Zuliani G, Eloy JA, Folbe AJ (2018) Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence-based review. Internat Forum Allergy Rhinol 20:837–849CrossRef Svider PF, Nguyen B, Yuhan B, Zuliani G, Eloy JA, Folbe AJ (2018) Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence-based review. Internat Forum Allergy Rhinol 20:837–849CrossRef
9.
go back to reference Gray ML, Fan CJ, Kappauf C, Kidwai S, Colley P, Iloreta AM et al (2018) Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society. Internat Forum Allergy Rhinol 18:1199–1203CrossRef Gray ML, Fan CJ, Kappauf C, Kidwai S, Colley P, Iloreta AM et al (2018) Postoperative pain management after sinus surgery: a survey of the American Rhinologic Society. Internat Forum Allergy Rhinol 18:1199–1203CrossRef
10.
go back to reference Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A et al (2008) Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth 20:103–108CrossRef Sener M, Yilmazer C, Yilmaz I, Bozdogan N, Ozer C, Donmez A et al (2008) Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone. J Clin Anesth 20:103–108CrossRef
11.
go back to reference Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A et al (2012) The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Practice 12:399–412CrossRef Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A et al (2012) The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Practice 12:399–412CrossRef
12.
go back to reference Higashizawa T, Koga Y (2001) Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. J Anesth 15:136–138CrossRef Higashizawa T, Koga Y (2001) Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. J Anesth 15:136–138CrossRef
13.
go back to reference Al-Qudah M (2016) Endoscopic sphenopalatine ganglion blockade efficacy in pain control after endoscopic sinus surgery. Internat Forum Allergy Rhinol 2:334–338CrossRef Al-Qudah M (2016) Endoscopic sphenopalatine ganglion blockade efficacy in pain control after endoscopic sinus surgery. Internat Forum Allergy Rhinol 2:334–338CrossRef
14.
go back to reference Kesimci E, Öztürk L, Bercin S, Kırış M, Eldem A, Kanbak O (2012) Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 269:165–169CrossRef Kesimci E, Öztürk L, Bercin S, Kırış M, Eldem A, Kanbak O (2012) Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 269:165–169CrossRef
15.
go back to reference DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine AI (2012) Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy 26:e23–e27CrossRef DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine AI (2012) Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy 26:e23–e27CrossRef
16.
go back to reference Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH (2011) The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Internat Forum Allergy Rhinol 3:212–218CrossRef Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH (2011) The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Internat Forum Allergy Rhinol 3:212–218CrossRef
17.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef
18.
go back to reference HigginsJPT G (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. Cochrane Collabo HigginsJPT G (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. Cochrane Collabo
19.
go back to reference Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17:1–12CrossRef Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17:1–12CrossRef
20.
go back to reference Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989CrossRef Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989CrossRef
21.
go back to reference Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Statist Med 21:1539–1558CrossRef Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Statist Med 21:1539–1558CrossRef
22.
go back to reference Ali AR, Sakr SA, Rahman ASM (2010) Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during endoscopic trans-nasal resection of pituitary adenoma. Egyptian J Anaesth 26:273–280CrossRef Ali AR, Sakr SA, Rahman ASM (2010) Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during endoscopic trans-nasal resection of pituitary adenoma. Egyptian J Anaesth 26:273–280CrossRef
23.
go back to reference Ismail SA, Anwar HM (2005) Bilateral sphenopalatine ganglion block in functional endoscopic sinus surgery under general anaesthesia. Ajaic 8:45–53 Ismail SA, Anwar HM (2005) Bilateral sphenopalatine ganglion block in functional endoscopic sinus surgery under general anaesthesia. Ajaic 8:45–53
24.
go back to reference Kent S, Mehaffey G (2016) Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 34:194–196CrossRef Kent S, Mehaffey G (2016) Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 34:194–196CrossRef
25.
go back to reference Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L IV, Kuruvilla D et al (2016) The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache J Head Face Pain 56:240–258CrossRef Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L IV, Kuruvilla D et al (2016) The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache J Head Face Pain 56:240–258CrossRef
26.
go back to reference Mojica J, Mo B, Ng A (2017) Sphenopalatine ganglion block in the management of chronic headaches. Curr Pain Head Reports 21:27CrossRef Mojica J, Mo B, Ng A (2017) Sphenopalatine ganglion block in the management of chronic headaches. Curr Pain Head Reports 21:27CrossRef
27.
go back to reference Cohen S, Levin D, Mellender S, Zhao R, Patel P, Grubb W et al (2018) Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients. Retrospect Rev 43(8):880–884 Cohen S, Levin D, Mellender S, Zhao R, Patel P, Grubb W et al (2018) Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients. Retrospect Rev 43(8):880–884
28.
go back to reference Krieger B, Qiao M, Rousso DL, Sanes JR, Meister M (2017) Four alpha ganglion cell types in mouse retina: function, structure, and molecular signatures. PLoS ONE 12:e0180091CrossRef Krieger B, Qiao M, Rousso DL, Sanes JR, Meister M (2017) Four alpha ganglion cell types in mouse retina: function, structure, and molecular signatures. PLoS ONE 12:e0180091CrossRef
29.
go back to reference Toto L, Borrelli E, Mastropasqua R, Senatore A, Di Antonio L, Di Nicola M et al (2016) Macular features in retinitis pigmentosa: correlations among ganglion cell complex thickness, capillary density, and macular function. Invest Ophthalmol Visual Sci 57:6360–6366CrossRef Toto L, Borrelli E, Mastropasqua R, Senatore A, Di Antonio L, Di Nicola M et al (2016) Macular features in retinitis pigmentosa: correlations among ganglion cell complex thickness, capillary density, and macular function. Invest Ophthalmol Visual Sci 57:6360–6366CrossRef
30.
go back to reference Lefkovitz M, Goldstein S, Lebovits A (1989) An anesthesiologist’s perspective in management of facial, head and neck pain. WB Saunders co, Philadelpia Lefkovitz M, Goldstein S, Lebovits A (1989) An anesthesiologist’s perspective in management of facial, head and neck pain. WB Saunders co, Philadelpia
31.
go back to reference Tyler MA, Lam K, Ashoori F, Cai C, Kain JJ, Fakhri S et al (2017) Analgesic effects of intravenous acetaminophen vs placebo for endoscopic sinus surgery and postoperative pain: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 143:788–794CrossRef Tyler MA, Lam K, Ashoori F, Cai C, Kain JJ, Fakhri S et al (2017) Analgesic effects of intravenous acetaminophen vs placebo for endoscopic sinus surgery and postoperative pain: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 143:788–794CrossRef
32.
go back to reference Chowdhury NI, Turner JH, Dorminy C, Wu J, Chandra RK (2019) Preoperative quality-of-life measures predict acute postoperative pain in endoscopic sinus surgery. Laryngoscope 129:1274–1279CrossRef Chowdhury NI, Turner JH, Dorminy C, Wu J, Chandra RK (2019) Preoperative quality-of-life measures predict acute postoperative pain in endoscopic sinus surgery. Laryngoscope 129:1274–1279CrossRef
33.
go back to reference Becker SD, Becker DG (2018) Review and update on postoperative opioid use after nasal and sinus surgery. Curr Opin Otolaryngol Head Neck Surg 26:41–45CrossRef Becker SD, Becker DG (2018) Review and update on postoperative opioid use after nasal and sinus surgery. Curr Opin Otolaryngol Head Neck Surg 26:41–45CrossRef
34.
go back to reference Hwang JH, Liu CM, Liu TC, Hsu MC (2003) Sphenopalatine ganglion block before removal of nasal packing. Laryngoscope 113:1423–1424CrossRef Hwang JH, Liu CM, Liu TC, Hsu MC (2003) Sphenopalatine ganglion block before removal of nasal packing. Laryngoscope 113:1423–1424CrossRef
Metadata
Title
The efficacy of sphenopalatine ganglion block for pain management after endoscopic sinus surgery: a meta-analysis of randomized controlled studies
Author
Ping Wang
Publication date
01-08-2021
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 8/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-06484-9

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