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Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review

Part of: JLO Editors' Choice Papers 2022

Published online by Cambridge University Press:  24 November 2021

E Watts ,
A Thompson ,
M Pankhania ,
O Okonkwo  and
S Ahmed
E Watts
Affiliation:
Department of ENT Surgery, Queen Elizabeth Hospital, Birmingham, UK
A Thompson
Affiliation:
Department of Oral and Maxillofacial Surgery, Royal Hallamshire Hospital, Sheffield, UK
M Pankhania
Affiliation:
Department of ENT Surgery, Queen Elizabeth Hospital, Birmingham, UK
O Okonkwo
Affiliation:
Department of ENT Surgery, Queen Elizabeth Hospital, Birmingham, UK
S Ahmed*
Affiliation:
Department of ENT Surgery, Queen Elizabeth Hospital, Birmingham, UK
*
Author for correspondence: Mr S Ahmed, Department of ENT Surgery, Queen Elizabeth Hospital, Mindelsohn Way, BirminghamB15 2GW, UK E-mail: shahz.ahmed@nhs.net
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Abstract

Objective

Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques.

Method

A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic.

Results

The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure.

Conclusion

Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

Keywords

Local Anesthetic Endoscopic Sinus Surgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 8 , August 2022 , pp. 683 - 691
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Mr S Ahmed takes responsibility for the integrity of the content of the paper

References

Campbell, JP, Cherri, DC, Warren, DW, Prazma, TU, Pillsbury, HC. Comparison of the vasoconstrictive and anesthetic effects of intranasally applied cocaine vs. xylometazoline/lidocaine solution. Otolaryngol Neck Surg 1992;107:697–70010.1177/019459989210700511CrossRefGoogle ScholarPubMed
Friedman, M, Venkatesan, TK, Lang, D, Caldarelli, DD. Bupivacaine for postoperative analgesia following endoscopic sinus surgery. Laryngoscope 1996;106:1382–510.1097/00005537-199611000-00014CrossRefGoogle ScholarPubMed
Meechan, JG, Czachur, KJ, McCabe, JF, Blair, GS. The ability of traditional and self-aspirating dental local anaesthetic cartridges to aspirate blood under simulated arterial conditions. Br Dent J 1986;160:239–4110.1038/sj.bdj.4805822CrossRefGoogle ScholarPubMed
Solomon, EGR, Arunachalam, KS. The incisive papilla: a significant landmark in prosthodontics. J Indian Prosthodont Soc 2012;12:236–4710.1007/s13191-012-0169-yCrossRefGoogle ScholarPubMed
Malamed, SF. Handbook of Local Anesthesia, 7th edn. Los Angeles: Elsevier, 2019Google Scholar
Kampitak, W, Tansatit, T, Shibata, Y. A cadaveric study of ultrasound-guided maxillary nerve block via the pterygopalatine fossa: a novel technique using the lateral pterygoid plate approach. Reg Anesth Pain Med 2018;43:625–3010.1097/AAP.0000000000000790CrossRefGoogle ScholarPubMed
Dalziel, K, Stein, K, Round, A, Garside, R, Royle, P. Endoscopic sinus surgery for the excision of nasal polyps: A systematic review of safety and effectiveness. Am J Rhinol 2006;20:506–1910.2500/ajr.2006.20.2923CrossRefGoogle ScholarPubMed
Lee, WC, Kapur, TR, Ramsden, WN. Local and regional anesthesia for functional endoscopic sinus surgery. Ann Otol Rhinol Laryngol 1997;106:767–910.1177/000348949710600910CrossRefGoogle ScholarPubMed
Devereaux, PJ, Xavier, D, Pogue, J, Guyatt, G, Sigamani, A, Garutti, I et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 2011;154:523–810.7326/0003-4819-154-8-201104190-00003CrossRefGoogle ScholarPubMed
Pannucci, CJ, Bailey, SH, Dreszer, G, Fisher Wachtman, C, Zumsteg, JW, Jaber, RM et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg 2011;212:105–1210.1016/j.jamcollsurg.2010.08.018CrossRefGoogle ScholarPubMed
Cook, TM, Woodall, N, Frerk, C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011;106:617–3110.1093/bja/aer058CrossRefGoogle Scholar
Strom, C, Rasmussen, LS, Sieber, FE. Should general anaesthesia be avoided in the elderly? Anaesthesia 2014;69:35–4410.1111/anae.12493CrossRefGoogle ScholarPubMed
McHardy, FE, Chung, F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999;54:444–5310.1046/j.1365-2044.1999.00780.xCrossRefGoogle ScholarPubMed
Kalingarayar, S, Nandhakumar, A, Subramanian, S, Namboothiri, S. Airway trauma during difficult intubation… from the frying pan into the fire? Indian J Anaesth 2017;61:437–910.4103/ija.IJA_140_17CrossRefGoogle Scholar
Vogel, J, Stubinger, S, Kaufmann, M, Krastl, G, Filippi, A. Dental injuries resulting from tracheal intubation--a retrospective study. Dent Traumatol 2009;25:73–710.1111/j.1600-9657.2008.00670.xCrossRefGoogle ScholarPubMed
Mota, LAA, de Cavalho, GB, Brito, VA. Laryngeal complications by orotracheal intubation: literature review. Int Arch Otorhinolaryngol 2012;16:236–45Google ScholarPubMed
Berg, LF, Mafee, MF, Campos, M, Applebaum, EL. Mechanisms of pneumothorax following tracheal intubation. Ann Otol Rhinol Laryngol 1988;97:500–510.1177/000348948809700512CrossRefGoogle ScholarPubMed
Stoelting, RK. Circulatory changes during direct laryngoscopy and tracheal intubation: influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977;47:381–410.1097/00000542-197710000-00012CrossRefGoogle ScholarPubMed
Jourdy, DN, Kacker, A. Regional anesthesia for office-based procedures in otorhinolaryngology. Anesthesiol Clin 2010;28:457–6810.1016/j.anclin.2010.07.004CrossRefGoogle ScholarPubMed
Roger, VL. Epidemiology of heart failure. Circ Res 2013;113:646–5910.1161/CIRCRESAHA.113.300268CrossRefGoogle ScholarPubMed
Davies, JD. Orthopnea in obese adult patients: can it be quantified from lung function testing? Respiratory care 2016;61:1133–410.4187/respcare.05057CrossRefGoogle ScholarPubMed
Gan, EC, Habib, A-RR, Rajwani, A, Javer, AR. Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2014;4:61–810.1002/alr.21249CrossRefGoogle ScholarPubMed
Ghanem, M, Elmalt, A. Local anesthesia with sedation versus local anesthesia after general anesthesia for sinus surgery: a randomized trial. Res Opin Anesth Intensive Care 2017;4:188–9410.4103/roaic.roaic_111_16CrossRefGoogle Scholar
Knight, DJW, Mahajan, RP. Patient positioning in anaesthesia. Contin Educ Anaesth Crit Care Pain 2004;4:160–310.1093/bjaceaccp/mkh044CrossRefGoogle Scholar
Enderby, GE. Pharmacological blockade. Postgrad Med J 1974;50:572–510.1136/pgmj.50.587.572CrossRefGoogle ScholarPubMed
Hathorn, IF, Habib, A-RR, Manji, J, Javer, AR. Comparing the reverse Trendelenburg and horizontal position for endoscopic sinus surgery: a randomized controlled trial. Otolaryngol Head Neck Surg 2013;148:308–1310.1177/0194599812466529CrossRefGoogle ScholarPubMed
Krings, JG, Kallogjeri, D, Wineland, A, Nepple, KG, Piccirillo, JF, Getz, AE. Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2014;124:838–4510.1002/lary.24401CrossRefGoogle ScholarPubMed
Cumberworth, VL, Sudderick, RM, Mackay, IS. Major complications of functional endoscopic sinus surgery. Clin Otolaryngol Allied Sci 1994;19:248–5310.1111/j.1365-2273.1994.tb01225.xCrossRefGoogle ScholarPubMed
Fedok, FG, Ferraro, RE, Kingsley, CP, Fornadley, JA. Operative times, postanesthesia recovery times, and complications during sinonasal surgery using general anesthesia and local anesthesia with sedation. Otolaryngol Head Neck Surg 2000;122:560–6Google ScholarPubMed
Hosemann, W, Draf, C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013;12:6Google ScholarPubMed
Milonski, J, Zielinska-Blizniewska, H, Golusinski, W, Urbaniak, J, Sobanski, R, Olszewski, J. Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2013;270:2045–5010.1007/s00405-012-2311-1CrossRefGoogle ScholarPubMed
Tan, PY, Poopalalingam, R. Anaesthetic concerns for functional endoscopic sinus surgery. Proc Singapore Healthc 2014;23:246–5310.1177/201010581402300310CrossRefGoogle Scholar
Simpson, P. Perioperative blood loss and its reduction: the role of the anaesthetist. Br J Anaesth 1992;69:498–50710.1093/bja/69.5.498CrossRefGoogle ScholarPubMed
Elsharnouby, NM, Elsharnouby, MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth 2006;96:727–3110.1093/bja/ael085CrossRefGoogle ScholarPubMed
Wormald, PJ, Athanasiadis, T, Rees, G, Robinson, S. An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery. Am J Rhinol 2005;19:288–9210.1177/194589240501900313CrossRefGoogle ScholarPubMed
Choi, WS, Samman, N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 2008;37:687–70310.1016/j.ijom.2008.03.011CrossRefGoogle ScholarPubMed
Nishimura, S, Suzuki, A, Hatazawa, J, Nishimura, H, Shirane, R, Yasui, N et al. Cerebral blood-flow responses to induced hypotension and to CO2 inhalation in patients with major cerebral artery occlusive disease: a positron-emission tomography study. Neuroradiology 1999;41:73–910.1007/s002340050709CrossRefGoogle ScholarPubMed
Yang, JJ, Li, WY, Jil, Q, Wang, ZY, Sun, J, Wang, QP et al. Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine-containing solutions of lidocaine produces profound hypotension. Acta Anaesthesiol Scand 2005;49:1471–610.1111/j.1399-6576.2005.00869.xCrossRefGoogle ScholarPubMed
Yang, JJ, Wang, QP, Wang, TY, Sun, J, Wang, ZY, Zuo, D et al. Marked hypotension induced by adrenaline contained in local anesthetic. Laryngoscope 2005;115:348–5210.1097/01.mlg.0000154752.94055.72CrossRefGoogle ScholarPubMed
Enlund, M, Mentell, O, Krekmanov, L. Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia. Acta Anaesthesiol Scand 2001;45:294–710.1034/j.1399-6576.2001.045003294.xCrossRefGoogle ScholarPubMed
Phillips, S, Hutchinson, SE, Bayly, P, Hollway, TE. Adrenaline-induced hypotension in neurosurgery. Br J Anaesth 1993;70:687–810.1093/bja/70.6.687CrossRefGoogle ScholarPubMed
Tanaka, M, Nishikawa, T. Efficacy of simulated intravenous test dose in the elderly during general anesthesia. Reg Anesth Pain Med 1999;24:393–810.1097/00115550-199924050-00004CrossRefGoogle ScholarPubMed
Thomas, RD, Behbehani, MM, Coyle, DE, Denson, DD. Cardiovascular toxicity of local anesthetics: an alternative hypothesis. Anesth Analg 1986;65:444–5010.1213/00000539-198605000-00003CrossRefGoogle Scholar
Sia, S, Sarro, F, Lepri, A, Bartoli, M. The effect of exogenous epinephrine on the incidence of hypotensive/bradycardic events during shoulder surgery in the sitting position during interscalene block. Anesth Analg 2003;97:583–810.1213/01.ANE.0000070232.06352.48CrossRefGoogle ScholarPubMed
Cohen-Kerem, R, Brown, S, Villasenor, LV, Witterick, I. Epinephrine/lidocaine injection vs. saline during endoscopic sinus surgery. Laryngoscope 2008;118:1275–8110.1097/MLG.0b013e31816dd2d9CrossRefGoogle ScholarPubMed
Wilhelmi, BJ, Blackwell, SJ, Miller, JH, Mancoll, JS, Dardano, T, Tran, A et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg 2001;107:393–710.1097/00006534-200102000-00014CrossRefGoogle ScholarPubMed
Hafner, H-M, Rocken, M, Breuninger, H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges 2005;3:195–910.1111/j.1610-0378.2005.04758.xCrossRefGoogle ScholarPubMed
Guimaraes, CC, Lopes Motta, RH, Bergamaschi, CDC, Araújo, JDO, Andrade, NK De, Figueiró, MF et al. Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-Analysis protocol. BMJ Open 2017;22:e01461110.1136/bmjopen-2016-014611CrossRefGoogle Scholar
Godzieba, A, Smektała, T, Jedrzejewski, M, Sporniak-Tutak, K. Clinical assessment of the safe use local anaesthesia with vasoconstrictor agents in cardiovascular compromised patients: a systematic review. Medical Science Monitor 2014;20:393–8Google ScholarPubMed
Meyer, FU. Haemodynamic changes under emotional stress following a minor surgical procedure under local anaesthesia. Int J Oral Maxillofac Surg 1987;16:688–9410.1016/S0901-5027(87)80054-1CrossRefGoogle ScholarPubMed
Caner, G, Olgun, L, Gultekin, G, Aydar, L. Local anesthesia for middle ear surgery. Otolaryngol Head Neck Surg 2005;133:295–710.1016/j.otohns.2004.09.112CrossRefGoogle ScholarPubMed
Sorensen, WT, Wagner, N, Aarup, AT, Bonding, P. Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. A placebo-controlled clinical trial. Auris Nasus Larynx 2003;30:159–6210.1016/S0385-8146(03)00047-6CrossRefGoogle ScholarPubMed
Lee, K, Yoo, BH, Yon, JH, Kim, K-M, Kim, M-C, Lee, WY et al. General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture. Korean J Anesthesiol 2013;65:209–1410.4097/kjae.2013.65.3.209CrossRefGoogle ScholarPubMed
Metzinger, SE, Bailey, DJ, Boyce, RG, Lyons, GD. Local anesthesia in rhinoplasty: a new twist? Ear Nose Throat J 1992;71:405–610.1177/014556139207100910CrossRefGoogle ScholarPubMed
Buyukkocak, U, Ozcan, S, Daphan, C, Apan, A, Koc, C. A comparison of four intravenous sedation techniques and Bispectral Index monitoring in sinonasal surgery. Anaesth Intensive Care 2003;31:164–7110.1177/0310057X0303100204CrossRefGoogle ScholarPubMed
Scamman, FL, Klein, SL, Choi, WW. Conscious sedation for procedures under local or topical anesthesia. Ann Otol Rhinol Laryngol 1985;94:21–410.1177/000348948509400105CrossRefGoogle ScholarPubMed
Thompson, AM, Wright, DJ, Murray, W, Ritchie, GL, Burton, HD, Stonebridge, PA. Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement? Surg Endosc 2004;18:22–5Google Scholar
Cho, D-Y, 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;1:212–810.1002/alr.20040CrossRefGoogle ScholarPubMed
Kesimci, E, Ozturk, L, Bercin, S, Kiris, M, Eldem, A, Kanbak, O. Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2012;269:165–910.1007/s00405-011-1702-zCrossRefGoogle ScholarPubMed
DeMaria, SJ, Govindaraj, S, Chinosorvatana, N, Kang, S, Levine, AI. Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy 2012;26:e23–710.2500/ajra.2012.26.3709CrossRefGoogle ScholarPubMed
Hassan Ahmed EHA-Z. Role of intraoperative endoscopic sphenopalatine ganglion block in sinonasal surgery. J Med Sci 2007;7:1297–30310.3923/jms.2007.1297.1303CrossRefGoogle Scholar
Shamil, E, Rouhani, MJ, Basetti, S, Bast, F, Hopkins, C, Surda, P. Role of local anaesthetic nerve block in endoscopic sinus surgery: a systematic review and meta-analysis. Clin Otolaryngol 2018;43:1201–810.1111/coa.13128CrossRefGoogle ScholarPubMed
Jespersen, MS, Jaeger, P, Ægidius, KL, Fabritius, ML, Duch, P, Rye, I et al. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial. Br J Anaesth 2020;124:739–4710.1016/j.bja.2020.02.025CrossRefGoogle ScholarPubMed
Jonas, N, Viani, L, Walsh, M. Sphenopalatine artery ligation under local anesthesia: a report of two cases and review of the literature. Local Reg Anesth 2010;3:1–410.2147/LRA.S6770CrossRefGoogle ScholarPubMed