A Prospective, Randomized Clinical Trial to Evaluate Analgesic Efficacy of Bilateral Pterygopalatine Fossa Injection in Patients Undergoing Maxillofacial Cancer Surgeries Under General Anesthesia

Figures & data

Figure 1. Redrawing diagram depicting relationships of trigeminal nerve, sphenopalatine ganglion (SPG) and the three divisions of the trigeminal nerve [3]

Figure 2. Ultrasound-guided pterygopalatine fossa (PPF) block

Table 1. Average category scale (10)

0	No bleeding
1	Slight bleeding – no suctioning of blood required
2	Slight bleeding – occasional suctioning required. Surgical field not threatened
3	Slight bleeding – frequent suctioning required. Bleeding threatens surgical field a few seconds after suction is removed
4	Moderate bleeding – frequent suctioning required. Bleeding threatens surgical field directly after suction is removed
5	Severe bleeding – constant suctioning required. Bleeding appears faster than can be removed by suction. Surgical field severely threatened and surgery not possible

Group (A) (n = 24): ultrasound-guided PPF (pterygopalatine fossa) block

Group (B) (n = 24): ultrasound-guided PPF (pterygopalatine fossa) injection with saline.

The VAS score was significantly lower in group A than group B until the 18th hour postoperatively (P < 0.0001)

Table 2. Demographic and operative data in both groups [mean ±SD, number (%)]

	Group A (U/S PPF block) (n = 24)	Group B (U/S PPF saline) (n = 24)	P-value
Age (years)	47 ± 12	48 ± 13	0.8
Weight (kg)	78 ± 9.8	76 ± 10.97	0.4
Type of operation Maxilla Mandible Alveolar margin Tongue	8 (33.3%) 5 (28.8%) 4 (16.7%) 7 (29.2%)	6(25%) 7(29.2%) 6(25%) 5(20.8%)
Time required to perform the procedure (min) Right Left	6 ± 1 6 ± 1	6 ± 1 6 ± 1	0.7 0.8

No statistically significant differences.

U/S, ultrasound; PPF, pterygopalatine fossa.

Figure 3. Flow chart of the enrolled cases

Figure 4. Postoperative visual analog scale (VAS) score

Table 3. Postoperative analgesic requirements in the post-anesthesia care unit [mean ±SD, number (%)]

	Group A (U/S PPF block) (n = 24)	Group B (U/S PPF saline) (n = 24)	P-value
Cases needed nalbuphine [n (%)]:	12 (50.0)	24 (100.0)	0.000*
Total nalbuphine dose (mg):			0.006*
Mean ± SD	10.00 ± 1.95	19.5 ± 4.95

*Significant compared to the U/S PPF saline group (P-value <0.05).

U/S, ultrasound; PPF, pterygopalatine fossa.

Table 4. Intraoperative data in both groups (mean ± SD)

	Group A (U/S PPF block) (n = 24)	Group B (U/S PPF saline) (n = 24)	P-value
Duration of surgery (h)	3 ± 1	4 ± 1	0.7
Blood loss (mL)	995 ± 322	1418 ± 288	<0.001**
ACS	3 ± 1	4 ± 1	0.003**
Sevoflurane concentration	2 ± 1	3 ± 0.5	0.019**
Nitroglycrine dose (µg/kg/min)	2 ± 1	4 ± 1	<0.05**
Emergence time (min)	7 ± 2	10 ± 2	<0.001**
Modified Aldrete score time (min)^a	10 ± 2	14 ± 3	<0.001**

.

^aTime for modified Aldrete score is the time taken to achieve a score of 9 or higher.

** Significant compared to the U/S PPF saline group (P-value <0.05).

ACS, Average Category Score; U/S, ultrasound; PPF, pterygopalatine fossa.

Table 5. Postoperative complications within 24 h of surgery [number (%)]

	Group A (U/S PPF block) (n = 24)	Group B (U/S PPF saline) (n = 24)
Headache	5 (20.8%)	7 (29.2%)
Bleeding	5(20.8%)	6 (25%)
N&V	8 (33.3%)	10 (41.7%)
Visual disturbance	0	0

U/S, ultrasound; PPF, pterygopalatine fossa; N&V, nausea and vomiting.

Waxman S. Correlative neuroanatomy. 23rd ed. Stanford: Appleton & Lange; 1996. p. 265–266.

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