Bali Journal of Anesthesiology · Published 2026-04-01 · DOI 10.4103/bjoa.bjoa_52_26
Background: Endoscopic transsphenoidal pituitary adenoma resection may provoke marked hemodynamic responses during nasal instrumentation and mucosal dissection. This trial compared the effects of bilateral infraorbital nerve block with those of topical intranasal bupivacaine packing for attenuation of intraoperative hemodynamic responses and improvement of early postoperative analgesic outcomes. Materials and Methods: In this single-center, parallel-group, randomized controlled trial, adults aged >21 years with American Society of Anesthesiologists physical status I–III scheduled for endoscopic transsphenoidal pituitary adenoma resection were enrolled between April 2022 and December 2025. Patients were randomized to receive either bilateral infraorbital nerve block with 0.5% bupivacaine or topical intranasal packs soaked with 0.5% bupivacaine after induction of general anesthesia. Patients and postoperative assessors were blinded to group allocation. The primary outcome was mean arterial pressure (MAP) during mucosal dissection. Secondary outcomes included postoperative pain scores, analgesic requirements, and adverse events. Results: Of 67 patients screened, 60 were randomized and analyzed, with 30 patients in each group. MAP was significantly lower in the intranasal packing group than in the infraorbital block (IOB) group at most time points after endoscope insertion, whereas baseline and post-intubation values did not differ significantly. Heart rate showed a similar pattern. Patients in the IOB group required more intraoperative rescue medications, including magnesium sulfate, fentanyl, propranolol, and nitroglycerin. Postoperative analgesic requirements were also higher after infraorbital block, including pethidine use (46.7% vs 10.0%; P = 0.002) and paracetamol use (73.3% vs 43.3%; P = 0.018). Pain scores at 6, 8, 12, and 24 h were significantly higher in the IOB. No adverse events were observed in either group. Conclusion: Topical intranasal bupivacaine packing provided better hemodynamic stability and postoperative analgesia than bilateral infraorbital nerve block during endoscopic transsphenoidal pituitary adenoma resection. Larger multicenter trials are warranted to confirm these findings.
Abstract from DOAJ. Public domain (CC0 1.0).
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