الفهرس 
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Abstract
Functional endoscopic sinus surgery (FESS) is the treatment modality of choice for the inflammatory disease of paranasal sinuses. Any surgery involving the nasal mucosa results in severe sympathetic stimulation, tachycardia and hypertension. These areas (nose and paranasal sinuses) are highly vascular and bleed easily which obscure endoscopic surgical field leading to prolongation of time of surgery with delayed recovery and bad surgical outcome.
General anesthesia is usually required during FESS, particularly complicated and prolonged cases. Nasal bleeding which may worsen the surgical field and bilateral hemostatic posterior nasal packing at the end of surgery represent challenges to the anesthetist.
Regional anesthetic techniques during general anesthesia is known to inhibit intraoperative and postoperative noxious stimuli, and can therefore, be used as a better alternative to high doses of narcotics avoiding their inconvenient drawbacks.
The sphenopalatine ganglion block was used effectively as a sole anesthetic technique before removal of nasal packing, and in patients undergoing endoscopic sinus surgery under general anesthesia to control bleeding or for postoperative analgesia.
Dexmedetomidine is α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, analgesic-sparing effects, used effectively in optimizing surgical field in patients undergoing endoscopic sinus surgery through its hemodynamic stability.
We aimed in this study to compare the efficacy of combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery in optimizing intraoperative surgical field.
This prospective randomized clinical trial study was conducted in seventy (70) patients ASA I or ASA II aged 18-65 years old were divided into two equal groups, group (A) received 1 µg/kg dexmedetomedine in 10 minutes after induction of anesthesia, followed by 0.7 µg/kg/hour during maintenance of anesthesia. group (B), immediately after induction of general anesthesia, regional nasal block by sphenopalatine ganglion block which was done via a transoral approach using 2ml of a mixture of lidocaine (2%) and bupivacaine (0.5%) for each side.
Results of this study showed surgical conditions were satisfactory in all patients of both groups, but significantly better with bilateral sphenopalatine ganglion block. Although the difference between both groups in MAP did not reach significance, the heart rate response to surgical stimulation was blunted more efficiently with a significantly reduced blood loss in the block group. A slow heart rate allows greater filling of the venous capacitance vessels, thus, decreasing venous oozing in the surgical field which measured by the average category scale (ACS).
Furthermore, intraoperative fentanyl consumption increased in dexmedetomidine group in comparison to sphenopalatine ganglion block group.
According to extubation time, patients in sphenopalatine ganglion block group were extubated faster than those in dexmedetomidine group.
Both groups showed satisfactory visual analogue scale (VAS) scores when compared to each other postoperatively although there was no statistical difference between them.
Also in this study, patients in dexmedetomidine group were sedated postoperatively in comparison to sphenopalatine ganglion block group according to Richmond agitation sedation scale (RASS).
There was no statistical difference between both groups according to postoperative complications except for dental numbness which was found to be highly significant in sphenopalatine ganglion block group.
In conclusion, both sphenopalatine ganglion block and dexmedetomidine were used effectively in patients undergoing endoscopic sinus surgery, but the sphenopalatine ganglion block was satisfactory in optimizing surgical field, less intraoperative narcotics consumption and had better recovery time than dexmedetomidine.