Postoperative Pain and Functional Patient Outcomes After Functional Endoscopic Sinus Surgery

Pain, Postoperative Clinical Trial

Official title:

The Effect of Preemptive Sphenopalatine Ganglion Block on Anesthetic Requirements, Postoperative Pain and Functional Patient Outcomes After Functional Endoscopic Sinus Surgery

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00927888
• Other study ID #: SU-05072009-2478
• Status: Completed
• Phase: Phase 4
• First received: June 23, 2009
• Last updated: November 16, 2015
• Start date: August 2007
• Est. completion date: August 2010

Study information

• Verified date: November 2015
• Source: Stanford University
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

The aim of the study is to quantify postoperative pain after functional endoscopic sinus surgery (FESS) and investigate whether preemptive analgesia may positively impact intraoperative anesthetic management, decrease patient postoperative pain and discomfort, and improve patient functional outcomes.

Description:

The sphenopalatine ganglion block (SPGB) with local anesthetic is used to treat facial pain and headache of various etiologies and has been widely used during functional endoscopic sinus surgery (FESS). The purpose of this study was to investigate whether preemptive SPGB may positively impact postoperative pain and functional outcomes after FESS.

A prospective, double-blind randomized placebo-controlled study was performed. 60 patients (18 to 70 yrs), undergoing general anesthesia for bilateral FESS, were randomly assigned to receive SPGB with either 2 ml 0.25% bupivacaine with epinephrine 1:100,000 (BP, treatment group) or normal saline (NS, control group). SPGB was performed preemptively 10 min before the start of surgery. Pre- and post operative (day#0, day#7, day#30) visual analogue pain scale, SNOT-20, CT & Endoscopic scores were compared between the two groups.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 56
• Est. completion date: August 2010
• Est. primary completion date: March 2010
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 70 Years

Eligibility

Inclusion Criteria:

1. The study subjects will be 18-70 year old.

2. The subjects will be American Society of Anesthesiology physical status I and II patients.

3. Patients with chronic rhinosinusitis, presenting for bilateral functional endoscopic sinus surgery.

4. The subjects should understand informed consent and study instructions, AND 5. The subjects should not participate in any other research protocols.

Exclusion Criteria:

1. Patients with pre-existing chronic facial pain not related to chronic rhinosinusitis.

2. Patients with pre-existing chronic pain of different etiology.

3. Patients taking prescription pain medications.

4. Patients taking antidepressant medications.

5. Patients taking over-the-counter pain medications within 48 hours of scheduled surgery.

6. Patients in whom oral opioid-containing analgesics would be contraindicated postoperatively.

7. Patients with a known or suspected genetic susceptibility to malignant hyperthermia, or known sensitivity to Desflurane or other halogenated agents.

8. Patients with the history of arrhythmias or significant coronary artery disease.

9. Patients with psychological disorders.

10. Patients who are unable to understand the questionnaires or the visual analogue scale (VAS) pain scores.

11. Patients with the history of substance or alcohol abuse.

12. Patients with compromised renal and liver function.

13. Patients with abnormal coagulation status or platelet count less than 100,000.

14. Pregnant patients.

15. Patients with an allergy to Bupivacaine, Lidocaine or Epinephrine.

16. Other patients that may be excluded by the investigator, based on medical history and physical examination

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Pain, Postoperative

Intervention

Drug:
• Bupivacaine Block
Bupivacaine local anesthesia block prior to start of FESS procedure.

Locations

Country	Name	City	State
United States	Stanford University School of Medicine	Stanford	California

Sponsors (2)

Lead Sponsor	Collaborator
Stanford University	Hospira, Inc.

Country where clinical trial is conducted

United States, 

References & Publications (1)

Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH. The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2011 May-Jun; — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Postoperative Pain Assessed on Standard VAS Scale	Post-operative quality of recovery and pain followed up to 1 month. Visual Analog Pain (VAS) was recorded by the patient on a 10-centimeter line to mark an estimated pain score that could be from zero (0) to ten (10). Zero would indicate no pain while a score of 10 would be the worse pain possible.	VAS Pain Score at 7 days	No
Secondary	SNOT-20 Surgical Outcome Score	This measures uses a 20 item surgical assessment tool to assess surgical field. This assessment score is the Sino-Nasal Outcome Test, SNOT-20. Patients were completed this validated sinus symptom questionnaire. The average magnitude score for the 20 items is calculated. Each item of the 20-question assessment is scored from 1 to 5 where 1 is less severe and 5 is a maximum as described by that particular symptom score. The final score is reported as a mean with a range of 0 (zero) to 5 (no units).; ref. Otolaryngol Head Neck Surg, 126 (2002), pp. 41-47	1-day	No