Efficacy of ultrasound-assisted pterygopalatine block using a posterior-to-anterior subzygomatic approach in eye enucleation: a prospective randomized comparative study

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Abstract

Background: Pterygopalatine block (PPB) is widely indicated in ophthalmology due to its simultaneous impact on sympathetic, parasympathetic, and nociceptive innervation. Ultrasound (US) guidance enhances block accuracy; however, clinical data on the efficacy of US-assisted PPB using different approaches remain limited.

Aim: To compare the efficacy of US-guided PPB using posterior-to-anterior subzygomatic and suprazygomatic approaches in patients undergoing eye enucleation.

Materials and methods: A prospective randomized study was conducted. For postoperative analgesia, PPB was performed in Group 1 (n=30) using the posterior-to-anterior subzygomatic approach and in Group 2 (n=30) using the suprazygomatic approach. The time required to perform the block, onset of analgesia, changes in arterial blood pressure (BP) and heart rate (HR), and technical aspects of block execution were evaluated.

Results: The interval between block administration and the onset of analgesia was significantly shorter in Group 1 (5.3±1.0 minutes) compared to Group 2 (10.1±1.4 minutes, p=0.041). Significant differences were also observed in the time to decreased skin sensitivity in the infraorbital area and time to pain relief: 8.9±0.9 and 13.5±0.7 minutes in Group 1 versus 14.4±1.2 and 19.6±1.7 minutes in Group 2 (p=0.037 and p=0.034, respectively). Mean arterial pressure and HR were lower in Group 1 (91.2±6.5 mmHg and 88.5±5.2 bpm) compared to Group 2 (101.1±6.6 mmHg and 105.3 ± 8.4 bpm, p=0.001). During the suprazygomatic PPB (Group 2), 53.3% (n=16) of patients reported discomfort, with a mean pain score of 2.3±0.5 on the numeric rating scale.

Conclusion: For managing pain after eye enucleation, ultrasound-assisted PPB using the posterior-to-anterior subzygomatic approach is the method of choice. Compared to the suprazygomatic approach, it provides faster onset of effective analgesia, greater patient comfort, and improved safety.

About the authors

Irina G. Oleshchenko

Fyodorov “Eye Microsurgery” Federal State Institution; Irkutsk State Medical University

Author for correspondence.
Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0003-1642-5276
SPIN-code: 8824-1216

MD, Cand. Sci. (Medicine), anesthesiologist-resuscitator, Irkutsk Branch

Russian Federation, 337 Lermontov street, 664033 Irkutsk; Irkutsk

Dmitrii V. Zabolotskii

Saint-Petersburg State Pediatric Medical University; Turner National Medical Research Center for Pediatric Traumatology and Orthopedics

Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 2 Litovskaya street, 194100 Saint Petersburg; Pushkin

Aleksandr V. Mankov

Irkutsk State Medical University

Email: man-aleksandrv@yandex.ru
ORCID iD: 0000-0001-8701-6432
SPIN-code: 7135-2828

MD, Cand. Sci. (Medicine), anesthesiologist-resuscitator

Russian Federation, Irkutsk

Victor A. Koriachkin

Saint-Petersburg State Pediatric Medical University; Turner National Medical Research Center for Pediatric Traumatology and Orthopedics

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 2 Litovskaya street, 194100 Saint Petersburg; Pushkin

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2. Fig. 1. The location of the sensor and the position of the needle when performing the ultrasound-navugated PPB (original drawing). Blue rectangle — sensor position, 1 — posterior-anterior infrazygomatic approach, 2 — supra-zygomatic approach, A, Б — needle position change).

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