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SurgeryNCT04339231

Block of the Sphenopalatine Nerve Ganglion for Postoperative Analgesia

A study testing sphenopalatine ganglion block in people with Surgery and Anesthesia, Local, run by Universidade Federal Fluminense at 1 site in Brazil.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Transsphenoidal surgery is considered safe and effective and is currently the procedure of choice for the removal of intrasellar lesions. Direct transnasal access to the sphenoid sinus, without the need for detachment of the nasal septum, provides less postoperative morbidity compared to traditional methods. Read more about this study

Who is it for?
Ages 18 to 64 yearsHealthy volunteers can take part
Conditions the study is for
Surgery, Anesthesia, Local, Postoperative Pain
What is being tested?
sphenopalatine ganglion block
Type of treatment
Surgery or procedure
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
40 participants
Where
1 siteBrazil
Study dates
25 Apr 2020to 25 Apr 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 64 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Both genders;
  • Age between 18 and 64 years;
  • Physical status according to the American Society of Anesthesiologists (ASA) I, II and III
  • Saddle or suprasellar tumors with transsphenoidal access;

Who cannot join

  • Participation in another study in the last month;
  • Patients with a history of chronic pain;
  • Previous surgeries with a transsphenoidal approach;
  • Known hypersensitivity to ropivacaine;
  • Patient's refusal;

Trial locations and contacts

1 site in 1 country.

Brynner M Bucard, Mr. contact

+55 32 99943-5055

probrynner@hotmail.com

Alexandra R Assad, MD. contact

+55 21 99985-9746

alexandraassad@hotmail.com

Brazil1 site
  • Instituto Estadual do Cérebro Paulo Niemeyer

    Rio de Janeiro, 20231-092

    Brynner M Bucard, Mr.

Other trials in Brazil

About this study

Official title: Block of the Sphenopalatine Nerve Ganglion for Postoperative Analgesia in Transsphenoidal Approaches: a Prospective, Randomized and Double-blind Study

Transsphenoidal surgery is considered safe and effective and is currently the procedure of choice for the removal of intrasellar lesions. Direct transnasal access to the sphenoid sinus, without the need for detachment of the nasal septum, provides less postoperative morbidity compared to traditional methods. Sphenopalatine ganglion block is known for its efficacy in otorhinolaryngological surgeries in which the sinuses are approached by transnasal endoscopy, as an important part of postoperative analgesia. However, in a neurosurgical environment, specifically in the treatment of tumors of the sella turcica, the use of the blockade of the referred ganglion to produce postoperative analgesia has been used in a scarce way in the literature. The primary objective of the study is to verify whether blocking the sphenopalatine nerve ganglion in the nasopharynx posterior wall provides better postoperative pain control in surgeries with nasal access for transsphenoidal approach, compared to the placebo group. As secondary objectives, the investigators will observe the consumption of opioids in the intraoperative period, in addition to the incidence of nausea, vomiting and postoperative headache also within 24 hours. Forty patients with physical status P1, P2 or P3 will be prospectively analyzed by the American Society of Anesthesiology (ASA) to undergo microsurgery for tumors with a sellar and / or suprasellar location, with transsphenoidal access, in patients with an age range between 18 and 64 years old, including men and women.

Read the detailed description

Transsphenoidal surgery is considered safe and effective and is currently the procedure of choice for the removal of intrasellar lesions. Direct transnasal access to the sphenoid sinus, without the need for detachment of the nasal septum, provides less postoperative morbidity compared to traditional methods. Sphenopalatine ganglion block is known for its efficacy in otorhinolaryngological surgeries in which the sinuses are approached by transnasal endoscopy, as an important part of postoperative analgesia. However, in a neurosurgical environment, specifically in the treatment of tumors of the sella turcica, the use of the blockade of the referred ganglion to produce postoperative analgesia has been used in a scarce way in the literature. The primary objective of the study is to verify whether blocking the sphenopalatine nerve ganglion in the nasopharynx posterior wall provides better postoperative pain control in surgeries with nasal access for transsphenoidal approach, compared to the placebo group. As secondary objectives, the investigators will observe the consumption of opioids in the intraoperative period, in addition to the incidence of nausea, vomiting and postoperative headache also within 24 hours. Forty patients with physical status P1, P2 or P3 will be prospectively analyzed by the American Society of Anesthesiology (ASA) to undergo microsurgery for tumors with a sellar and / or suprasellar location, with transsphenoidal access, in patients with an age range between 18 and 64 years old, including men and women. As for the surgical technique, both the use of the microscope and the endoscope will be considered. They will be randomly allocated to a placebo group (group P; 0.9% saline, n = 20) and a test group (group R; ropivacaine 1%, n = 20).

Being tested
sphenopalatine ganglion block
Keywords
ropivacaine, sphenopalatine
Medical subject headings
Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • sphenopalatine ganglion blockProcedure or surgery

    The block of the sphenopalatine ganglion will be performed bilaterally, using a cotton bud soaked with 1% ropivacaine, placed in the mucosa of the posterior wall of the nasal cavity, through both nostrils.

    Once placed in the proper position, the swab will remain for about 20 minutes to absorb the local anesthetic from the mucosa.

Study groups in NCT04339231
Study groupRoleWhat they receive
Ropivacaine groupActive comparatorThe block of the sphenopalatine ganglion will be performed bilaterally through a cotton bud soaked with the anesthetic solution ropivacaine, at a concentration of 1%, advancing it through the nasal cavities towards the posterior nasopharynx wall. A slight resistance in the progression of the cottonoid indicates its contact with the mucosa of the posterior pharyngeal wall. The cottonoid will remain in this position for 20 minutes, so that there is absorption of the anesthetic solution through the mucosa up to the sphenopalatine ganglion, which, in general, is found anatomically around 3 millimeters in depth from the surface. After the established time, the cotton buds are removed.
Receives: Procedure: sphenopalatine ganglion block
Saline 0,9% groupPlacebo comparatorThe block of the sphenopalatine ganglion will be performed bilaterally through a cotton bud soaked with saline solution, in a concentration of 0.9%, advancing it through the nasal cavities towards the posterior wall of the nasopharynx. A slight resistance in the progression of the cottonoid indicates its contact with the mucosa of the posterior pharyngeal wall. The cottonoid will remain in this position for 20 minutes, so that the solution is absorbed by the mucosa up to the sphenopalatine ganglion, which, in general, is anatomically three millimeters deep from the surface. After the established time, the cotton buds are removed.
Receives: Procedure: sphenopalatine ganglion block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain)

    To verify whether blocking the sphenopalatine nerve ganglion in the posterior nasopharynx wall provides change in postoperative pain control, assessed using the visual analogue pain scale, in surgeries with nasal access for transsphenoidal approach, compared to the placebo group.

    Measured: Immediately after awakening from anesthesia

  2. Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain)

    To verify whether blocking the sphenopalatine nerve ganglion in the posterior nasopharynx wall provides change in postoperative pain control, assessed using the visual analogue pain scale, in surgeries with nasal access for transsphenoidal approach, compared to the placebo group.

    Measured: 2 hours postoperative

  3. Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain)

    To verify whether blocking the sphenopalatine nerve ganglion in the posterior nasopharynx wall provides change in postoperative pain control, assessed using the visual analogue pain scale, in surgeries with nasal access for transsphenoidal approach, compared to the placebo group.

    Measured: 6 hours postoperative

  4. Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain)

    To verify whether blocking the sphenopalatine nerve ganglion in the posterior nasopharynx wall provides change in postoperative pain control, assessed using the visual analogue pain scale, in surgeries with nasal access for transsphenoidal approach, compared to the placebo group.

    Measured: 12 hours postoperative

  5. Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain)

    To verify whether blocking the sphenopalatine nerve ganglion in the posterior nasopharynx wall provides change in postoperative pain control, assessed using the visual analogue pain scale, in surgeries with nasal access for transsphenoidal approach, compared to the placebo group.

    Measured: 24 hours postoperative

Secondary outcomes (16)
  1. Change the consumption of intraoperative opioids

    Check the change in total opioid consumption in the intraoperative period

    Measured: Intraoperative time

  2. Use of complementary opioids

    Assess the number of rescue doses with opioids in pos operative period for for adequate analgesia (it is understood as insufficient analgesia classification on the visual analog scale of pain greater than or equal to 3)

    Measured: Immediately after awakening from anesthesia

  3. Use of complementary opioids

    Assess the number of rescue doses with opioids in pos operative period for for adequate analgesia (it is understood as insufficient analgesia classification on the visual analog scale of pain greater than or equal to 3)

    Measured: 2 hours postoperative

  4. Use of complementary opioids

    Assess the number of rescue doses with opioids in pos operative period for for adequate analgesia (it is understood as insufficient analgesia classification on the visual analog scale of pain greater than or equal to 3)

    Measured: 6 hours postoperative

  5. Use of complementary opioids

    Assess the number of rescue doses with opioids in pos operative period for for adequate analgesia (it is understood as insufficient analgesia classification on the visual analog scale of pain greater than or equal to 3)

    Measured: 12 hours postoperative

  6. Use of complementary opioids

    Assess the number of rescue doses with opioids in pos operative period for for adequate analgesia (it is understood as insufficient analgesia classification on the visual analog scale of pain greater than or equal to 3)

    Measured: 24 hours postoperative

  7. Postoperative nausea and vomiting;

    Check the incidence of postoperative nausea and vomiting

    Measured: Immediately after awakening from anesthesia

  8. Postoperative nausea and vomiting;

    Check the incidence of postoperative nausea and vomiting

    Measured: 2 hours postoperative

  9. Postoperative nausea and vomiting;

    Check the incidence of postoperative nausea and vomiting

    Measured: 6 hours postoperative

  10. Postoperative nausea and vomiting;

    Check the incidence of postoperative nausea and vomiting

    Measured: 12 hours postoperative

  11. Postoperative nausea and vomiting;

    Check the incidence of postoperative nausea and vomiting

    Measured: 24 hours postoperative

  12. Postoperative headache

    Check the incidence of postoperative headache

    Measured: Immediately after awakening from anesthesia

  13. Postoperative headache

    Check the incidence of postoperative headache

    Measured: 2 hours postoperative

  14. Postoperative headache

    Check the incidence of postoperative headache

    Measured: 6 hours postoperative

  15. Postoperative headache

    Check the incidence of postoperative headache

    Measured: 12 hours postoperative

  16. Postoperative headache

    Check the incidence of postoperative headache

    Measured: 24 hours postoperative

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Apr 2020
  2. Study start25 Apr 2020 (estimated)
  3. Primary completion25 Mar 2021 (estimated)
  4. Study completion25 Apr 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
XXXXX
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04339231
Sponsor's protocol ID
Sphenopalatine
Status last verified
Apr 2020
First submitted
31 Mar 2020
Last updated
13 Apr 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There are no plans to share individual patient data

Publications

  • Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg. 2001 Dec;95(6):1083-96. doi: 10.3171/jns.2001.95.6.1083.

    PubMed 11765830
  • Kesimci E, Ozturk L, Bercin S, Kiris M, Eldem A, Kanbak O. Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2012 Jan;269(1):165-9. doi: 10.1007/s00405-011-1702-z. Epub 2011 Jul 8.

    PubMed 21739090
  • Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH. The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2011 May-Jun;1(3):212-8. doi: 10.1002/alr.20040. Epub 2011 Apr 13.

    PubMed 22287376

Questions about this trial

What is this clinical trial studying?

A study testing sphenopalatine ganglion block in people with Surgery and Anesthesia, Local, run by Universidade Federal Fluminense at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 13 Apr 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Brynner M Bucard, Mr. (+55 32 99943-5055, probrynner@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Evaluation of postoperative analgesia using the visual analogue pain scale (VAS pain) (time frame: Immediately after awakening from anesthesia). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04339231, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Apr 2020.

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