#35942 Tubeless FESS: a minimally invasive anesthesia for a minimally invasive surgery

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Background and Aims

FESS (functional endoscopic sinus surgery) is a minimally invasive approach for paranasal sinuses surgery that treats numerous symptoms avoiding more complex surgical procedures. It is usually performed under general anesthesia, our aim was to find a suitable locoregional technique that could match the minimally invasive approach of the surgery.

Methods

Written informed consent was obtained from a 32 y/o male patient, ASA I. We performed bilateral infratrochlear nerve block with 1,5ml ropivacaine 7,5mg/ml for each side, bilateral infraorbital nerve block with 4ml ropivacaine 7,5mg/ml for each side, bilateral anterior ethmoidal nerve block with 3ml ropivacaine 7,5mg/ml for each side. All blocks were perfomed with standard 26G needle without ultrasound, using anatomical landmarks. Efficacy was tested via pin-prick test and endoscopic puncture of mid-turbinate by ENT specialist. Standard multiparametric monitoring and NOL PMD200™ monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) were used to assess nociception levels during surgery.

Results

The surgery was performed without complications with continuous infusion remifentanil (0,05 mcg/kg/min). No significant hemodynamic shift was registered during surgery and no other opioid was administered. NRS level was 0 at the end of the surgery as well as at patient discharge 3 hours later.

Conclusions

This locoregional technique has shown promise for FESS surgery, and we think it may be suitable for septoplasty and fracture repairs too. We plan to conduct a randomized control trial to further study the matter.