Can Regional Anaesthesia Reduce Postoperative Pain after Pituitary Surgery?

Pituitary adenomas are noncancerous tumors that form in the pituitary gland, a pea-sized organ located at the base of the brain. Transsphenoidal endonasal surgery is a common treatment for these tumors, which involves removing the tumor through the nasal cavity. Unfortunately, postoperative pain, headache, and nausea are common complications that can delay hospital discharge and increase the risk of other complications.

Clinical Trial

A clinical trial sought to determine if a regional anesthetic technique could reduce postoperative pain and opioid use in patients undergoing pituitary neurosurgery. The technique called bilateral superficial trigeminal nerve blocks of the supra-orbital V1 and infra-orbital V2 (SION) nerves, involves injecting a local anesthetic near the nerves that supply sensation to the forehead and cheek.

In this study, 49 patients were chosen and randomly put into two groups. One group received a special injection called the SION block, and the other group got a fake injection of saltwater. The main thing the study looked at was how much opioid medication each group needed for pain relief in the first 6 hours after surgery. They also checked for things like how much pain people had, if they felt sick to their stomach, and how long it took for them to be ready to leave the hospital.

Results

The study did not show a significant difference in the use of opioid medication between the two groups receiving either the SION block or a placebo injection. However, patients in the SION block group had slightly higher pain scores, used more morphine, and had delayed discharge from the post-anesthesia care unit. Further analysis did not reveal any significant differences between the two groups.

While the results of the study may be disappointing for those hoping for a simple solution to postoperative pain after pituitary surgery, they do provide valuable insight into the underlying mechanisms of postoperative headache. It appears that a 6-hour postoperative headache after endoscopic trans-sphenoidal pituitary surgery likely has a more complicated mechanism involving more than the superficial trigeminovascular system and may be neuro-modulated by other brain nuclei.

Despite the lack of a significant effect on pain and opioid use, the SION block technique remains a promising option for future research. Additional studies may be needed to refine the technique and identify patient subgroups that may benefit from regional anesthesia as an adjunct to general anesthesia.

Conclusion

Pituitary neurosurgery is a common procedure that can be complicated by postoperative pain, headache, and nausea. While the SION block technique did not significantly reduce opioid use in the first 6 hours postoperatively, it remains a promising option for future research. As always, patients should discuss the risks and benefits of any anesthesia technique with their healthcare provider prior to surgery.

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