The Role of Endoscopic Sphenopalatine Ganglion Block on Nausea and Vomiting After Sinus Surgery

Am J Rhinol Allergy. 2018 Sep;32(5):369-373. doi: 10.1177/1945892418782235. Epub 2018 Jun 27.


Background Postoperative nausea and vomiting (PONV) are among the most common unpleasant and distressing adverse events following surgery under general anesthesia. Functional endoscopic sinus surgery (FESS) is a common otolaryngology procedure. Prevention of PONV and early recovery are cost-effective. Objective The aim of this study was to evaluate the prophylactic effect of bilateral endoscopic injection of lidocaine with epinephrine in the sphenopalatine ganglion (SPG) on PONV in patients undergoing FESS. Methods One hundred patients with chronic rhinosinusitis undergoing general anesthesia for FESS were enrolled in this double-blind, placebo-controlled study. Patients were randomized to receive injection of 2 mL of 2% lidocaine with epinephrine or 2 mL of saline at the end of surgery. Postoperatively, patients were observed for 24 h. PONV was evaluated immediately, 6 h, and 24 h after surgery. Results The 2 groups were comparable in characteristic and intraoperative features. In general, the incidence of PONV after FESS was 36%. The average time that patients can tolerate oral feeding was 3.4 h after surgery. Endoscopic SPG injection with lidocaine significantly reduced the incidence of vomiting and PONV. In addition, SPG injection with lidocaine reduced the incidence of severe vomiting and decreased the number of vomiting episodes. No complications were encountered in either group. Conclusion SPG injection with lidocaine at the end of surgery is a safe, noninvasive, and an effective technique in reducing early PONV in endoscopic sinus surgery patients.

Keywords: complications; functional endoscopic sinus surgery; incidence; lidocaine; nausea; sphenopalatine ganglion block; vomiting.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anesthesia, General
  • Chronic Disease
  • Double-Blind Method
  • Drug Combinations
  • Endoscopy*
  • Epinephrine / therapeutic use
  • Female
  • Humans
  • Incidence
  • Jordan / epidemiology
  • Lidocaine / therapeutic use
  • Male
  • Middle Aged
  • Paranasal Sinuses / surgery*
  • Postoperative Nausea and Vomiting / epidemiology
  • Postoperative Nausea and Vomiting / prevention & control*
  • Rhinitis / epidemiology
  • Rhinitis / surgery*
  • Sinusitis / epidemiology
  • Sinusitis / surgery*
  • Sphenopalatine Ganglion Block*
  • Young Adult


  • Drug Combinations
  • Lidocaine
  • Epinephrine