Sphenopalatine ganglion block for pain control after septoplasty: a systematic review and meta-analysis with trial sequential analysis.

Abstract

Introduction: Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is still lacking. This systematic review and meta-analysis aim to comprehensively evaluate the analgesic efficacy of SPGB in septoplasty patients.

Methods: We systematically searched PubMed/Medline, Scopus, Web of Science, Embase, and CENTRAL from inception to April 10th, 2024. Randomized controlled trials (RCTs) were assessed using the RoB-2 tool. The primary outcomes were postoperative pain scores, analgesic consumption, surgery duration, postoperative nausea and vomiting (PONV), and patient satisfaction. Continuous data were pooled as mean difference (MD), and dichotomous data as risk ratio (RR) with a 95% confidence interval (CI) using STATA software. Additionally, trial sequential analysis (TSA) was conducted.

Results: Three RCTs with 180 patients were included. Two RCTs had a 'low risk' of bias, while one RCT had 'some concerns'. The SPGB group had significantly lower postoperative pain within 24 hours compared to controls, particularly after particularly after 1-2 hours (MD = -1.85), 4-6 hours (MD = -2.02), 12 hours (MD = -2.14), and 24 hours (MD = -2.36) TSA confirmed the conclusive evidence. Analgesic use was significantly reduced in the SPGB group. No significant differences were observed in surgery duration or PONV rates between groups. Patient satisfaction was significantly higher in the SPGB group.

Conclusion: SPGB demonstrates efficacy and safety in managing postoperative pain in patients undergoing septoplasty for DNS.