Effects of Infraorbital Nerve Block with Dexmedetomidine-Added Bupivacaine on Intraoperative Opioid Consumption and Postoperative Analgesia During Endoscopic Transsphenoidal Surgery: A Prospective, Randomized, Double-Blind Controlled Trial
Abstract
Purpose: In endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma, perioperative discomfort often requires opioid use under general anesthesia. Infraorbital nerve block (IONB), which targets nasal structures involved in ETSS-related pain, may improve analgesia. Combining dexmedetomidine with bupivacaine for IONB may further reduce intraoperative opioid requirements and improve recovery.
Patients and methods: In this prospective, randomized, double-blind study, total of 63 patients was randomized and undergoing ETSS received bilateral ultrasound-guided IONB and were assigned to dexmedetomidine + bupivacaine (2 mL of 0.5% bupivacaine with 5 µg dexmedetomidine per side), bupivacaine alone (2 mL of 0.5% per side), or control (2 mL of normal saline per side). 47 patients were included in the final analysis. The study aimed to evaluate the effects of IONB with dexmedetomidine-added bupivacaine on intra/postoperative analgesic requirements and postoperative pain scores. The study was registered on ClinicalTrials.gov (ID: NCT04785222) on 3 March 2021.
Results: The dexmedetomidine + bupivacaine group required significantly less intraoperative fentanyl (1.80 ± 0.67 mcg/kg) than the bupivacaine (2.26 ± 0.78 mcg/kg) and control (2.83 ± 1.87 mcg/kg) groups (p < 0.001). Adjusted analysis showed a mean difference reduction of 1.12 mcg/kg in fentanyl use in the dexmedetomidine added group (p = 0.037). Regarding postoperative analgesic requirements, the time to first rescue…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 63 participants or records.
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