Efficacy of ultrasound-guided suprazygomatic maxillary nerve block on emergence agitation and postoperative analgesia after septorhinoplasty: A prospective randomized trial

Background and Aims: Emergence agitation (EA) is frequently encountered following nasal surgeries, and postoperative pain is a significant contributing element. We aimed to assess the role of suprazygomatic maxillary nerve (MN) block (SMB) guided by ultrasound (US) in lowering EA incidence and enhancing analgesia quality in septorhinoplasty cases. Material and Methods: Sixty cases aged 18-60 years, of both genders, categorized by the American Society of Anesthesiologists (ASA) I-II and listed for septorhinoplasty, were randomized to receive general anesthesia (GA) with either no block (the control group) or combined with bilateral US-guided SMB (the SMB group). The incidence of EA, postoperative pain scores, total rescue 24-hour analgesic consumption, and incidence of adverse events were all noted. Results: EA incidence was significantly reduced in the SMB group than in the control group (five patients (16.7%) vs 14 patients (46.6%), respectively; P = 0.026). Pain scores at 30 minutes and 1, 2, 4, and 6 hours postoperative were significantly decreased in the SMB group (P = 0.024, 0.000, 0.000, 0.009, and 0.038, respectively), with significantly less morphine consumption at 24 hours postoperative in the SMB group compared with the control group (P = 0.000). No serious adverse events were noted. Conclusions: Preemptive application of US-guided SMB was effective in lowering EA incidence. Furthermore, it enhanced the analgesic quality and reduced the requirement for rescue analgesics in patients undergoing septorhinoplasty.