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Abstract
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Background and Aims FESS (functional endoscopic sinus surgery) is a minimally invasive approach for paranasal sinuses surgery that treats numerous symptoms avoiding more complex surgical procedures. It is usually performed under general anesthesia, our aim was to find a suitable locoregional technique that could match the minimally invasive approach of the surgery.
Methods Written informed consent was obtained from a 32 y/o male patient, ASA I. We performed bilateral infratrochlear nerve block with 1,5ml ropivacaine 7,5mg/ml for each side, bilateral infraorbital nerve block with 4ml ropivacaine 7,5mg/ml for each side, bilateral anterior ethmoidal nerve block with 3ml ropivacaine 7,5mg/ml for each side. All blocks were perfomed with standard 26G needle without ultrasound, using anatomical landmarks. Efficacy was tested via pin-prick test and endoscopic puncture of mid-turbinate by ENT specialist. Standard multiparametric monitoring and NOL PMD200™ monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) were used to assess nociception levels during surgery.
Results The surgery was performed without complications with continuous infusion remifentanil (0,05 mcg/kg/min). No significant hemodynamic shift was registered during surgery and no other opioid was administered. NRS level was 0 at the end of the surgery as well as at patient discharge 3 hours later.
Infratrochlear nerve block
Infraorbital nerve block
Ethmoidal nerve block
Conclusions This locoregional technique has shown promise for FESS surgery, and we think it may be suitable for septoplasty and fracture repairs too. We plan to conduct a randomized control trial to further study the matter.