Effects of Bilateral Infraorbital and Infratrochlear Nerve Block on Emergence Agitation after Septorhinoplasty: A Randomized Controlled Trial

Hoon Choi, Seung Ho Jung, Jin Myung Hong, Young Ho Joo, Youme Kim, Sang Hyun Hong, Hoon Choi, Seung Ho Jung, Jin Myung Hong, Young Ho Joo, Youme Kim, Sang Hyun Hong

Abstract

Emergence agitation is common after septorhinoplasty, and postoperative pain is the main risk factor for this condition. Infraorbital and infratrochlear nerve block have been reported to facilitate pain management in patients after nasal procedures. The effect of peripheral nerve block on the incidence of emergence agitation has not been evaluated. Sixty-six patients that were scheduled for septorhinoplasty were assigned to receive bilateral infraorbital and infratrochlear nerve block with either 8 mL of 0.5% ropivacaine (Block group) or isotonic saline (Sham Block group). The incidence of emergence agitation was evaluated using the Riker sedation-agitation scale. Analgesic consumption, hemodynamic parameters, postoperative pain scores, adverse events, and patient satisfaction with analgesia were evaluated. The incidence of emergence agitation was lower in the Block group than in the Sham Block group (6 (20.0%) versus 20 (62.5%), p = 0.002). The mean intraoperative remifentanil consumption was lower in the Block group than in the Sham Block group (0.074 ± 0.014 μg/kg/min. versus 0.093 ± 0.019 μg/kg/min., respectively, p < 0.0001), as was the proportion of patients that needed postoperative tramadol administration and median postoperative pain score at 0-2 h after surgery (9 (30.0%) versus 21 (65.6%), p = 0.011; 3.0 (2.0-4.0) versus 4.0 (3.0-4.0), p < 0.0001, respectively). Hemodynamic parameters and the incidence of adverse events were similar between the two groups. The median patient satisfaction score with respect to analgesia was higher in the Block group than in the Sham Block group (3.5 (3.0-4.0) versus 3.0 (3.0-4.0), respectively, p = 0.034). The preoperative bilateral infraorbital and infratrochlear nerve block decreased the incidence of emergence agitation after septorhinoplasty.

Keywords: anesthesia; emergence delirium; general; pain; postoperative.

Conflict of interest statement

The authors declare no conflict of interest

Figures

Figure 1
Figure 1
Infraorbital nerve block. 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 to avoid globe penetration injury.
Figure 2
Figure 2
Infratrochlear nerve block.
Figure 3
Figure 3
CONSORT flowchart of the study.
Figure 4
Figure 4
Incidence of emergence agitation (white) and severe emergence agitation (black).

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