Background: Nasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA.

Aim and Objectives: This study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of  the surgical field, bleeding volume, inhalational anesthesia MAC, VAS in the PACU, postoperative analgesia duration, and total 24-hour opioid consumption.

Patients and Methods: This double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: GI (sphenopalatine), which received general anesthesia and a bilateral sphenopalatine ganglion block with 5 ml lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 ml on each side.

Results: A significant decrease in the incidence of EA was found in the SPGB group compared to the control group (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in the SPGB group compared to the control group. Pain severity was significantly lower in the SPGB group in the PACU, and 24h postoperative opioid consumption was significantly reduced compared to the control group. Additionally, postoperative analgesia duration was significantly longer in the SPGB group compared to the control group (9 h vs. 3 h).

Conclusion: SPGB effectively reduced the incidence, severity, and duration of EA after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding,  improved surgical field quality, prolonged postoperative analgesia, and reduced 24- hour opioid consumption after sinoscopic nasal surgery.