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#35942 Tubeless FESS: a minimally invasive anesthesia for a minimally invasive surgery
  1. Fabio Costa1,
  2. Luigi Maria Remore1,
  3. Alessandro Strumia1,
  4. Laura Pierantoni1,
  5. Alessandro Ruggiero1,
  6. Felice Eugenio Agrò1,
  7. Manuele Casale2 and
  8. Antonio Moffa2
  1. 1Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
  2. 2Otorhinolaryngology, Campus Bio-Medico University Hospital, Rome, Italy


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

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.

Abstract #35942 Figure 1

Infratrochlear nerve block

Abstract #35942 Figure 2

Infraorbital nerve block

Abstract #35942 Figure 3

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.

  • face blocks
  • trigeminal nerve blocks
  • head blocks
  • ENT

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