Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis

Do Hyun Kim; Jun-Beom Park; Sung Won Kim; Gulnaz Stybayeva; Se Hwan Hwang

doi:10.3390/medicina59091659

Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis

Medicina (Kaunas). 2023 Sep 14;59(9):1659. doi: 10.3390/medicina59091659.

Authors

Do Hyun Kim¹, Jun-Beom Park², Sung Won Kim¹, Gulnaz Stybayeva³, Se Hwan Hwang⁴

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
² Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
³ Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.

Abstract

Background and Objectives: Through a comprehensive meta-analysis of the pertinent literature, this study evaluated the utility and efficacy of perioperative infraorbital and/or infratrochlear nerve blocks in reducing postoperative pain and related morbidities in patients undergoing septorhinoplasty. Materials and Methods: We reviewed studies retrieved from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to August 2023. The analysis included a selection of seven articles that compared a treatment group receiving perioperative infraorbital and/or infratrochlear nerve blocks with a control group that either received a placebo or no treatment. The evaluated outcomes covered parameters such as postoperative pain, the amount and frequency of analgesic medication administration, the incidence of postoperative nausea and vomiting, as well as the manifestation of emergence agitation. Results: The treatment group displayed a significant reduction in postoperative pain (mean difference = -1.7236 [-2.6825; -0.7646], I² = 98.8%), as well as a significant decrease in both the amount (standardized mean difference = -2.4629 [-3.8042; -1.1216], I² = 93.0%) and frequency (odds ratio = 0.3584 [0.1383; 0.9287], I² = 59.7%) of analgesic medication use compared to the control. The incidence of emergence agitation (odds ratio = 0.2040 [0.0907; 0.4590], I² = 0.0%) was notably lower in the treatment group. The incidence of postoperative nausea and vomiting (odds ratio = 0.5393 [0.1309; 2.2218], I² = 60.4%) showed a trend towards reduction, although it was not statistically significant. While no adverse effects reaching statistical significance were reported in the analyzed studies, hematoma (proportional rate = 0.2133 [0.0905; 0.4250], I² = 76.9%) and edema (proportional rate = 0.1935 [0.1048; 0.3296], I² = 57.2%) after blocks appeared at rates of approximately 20%. Conclusions: Infraorbital and/or infratrochlear nerve blocks for septorhinoplasty effectively reduce postoperative pain and emergence agitation without notable adverse outcomes.

Keywords: meta-analysis; nasal septum; nerve block; pain; rhinoplasty.

Publication types

Meta-Analysis
Review

MeSH terms

Emergence Delirium*
Humans
Nerve Block*
Pain, Postoperative / drug therapy
Pain, Postoperative / prevention & control
Postoperative Care
Postoperative Nausea and Vomiting / epidemiology
Postoperative Nausea and Vomiting / prevention & control

Grants and funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (RS-2023-00209494, 2022R1F1A1066232), and the Korean Fund for Regenerative Medicine (KFRM) grant funded by the Korea government (23C0121L1). The sponsors had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.