Efficacy and Safety of Sphenopalatine Ganglion Block Versus Infraorbital and Infratrochlear Nerve Blocks in Nasal and Sinus Surgeries: A Systematic Review and Network Meta-Analysis.

[INTRODUCTION] Pain management and hemodynamic stability during nasal and sinus surgeries remain challenging. Our study compared the efficacy and safety of sphenopalatine ganglion block (SPGB) versus infraorbital/infratrochlear nerve blocks (IOB/ITNB) across various nasal/sinus surgical procedures.

[METHODS] The authors conducted a systematic review and network meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, Google Scholar, Cochrane Library, and Web of Science were searched from inception up to May 20, 2025. Randomized controlled trials and observational studies comparing SPGB or IOB/ITNB versus control in adults undergoing nasal/sinus surgeries were included. Outcomes included pain scores, analgesic consumption, surgical field quality, recovery metrics, and adverse events. Random-effects models and Bayesian network meta-analysis were performed.

[RESULTS] Twenty studies with a total of 1098 patients were included: 12 SPGB and 8 IOB/ITNB. Both techniques significantly reduced early postoperative pain compared with control [SPGB: SMD=-1.37 (-1.86,-0.88); IOB/ITNB: SMD=-0.75 (-1.03,-0.47)], with SPGB showing greater efficacy [SMD=-0.62 (-1.18,-0.06) versus IOB/ITNB]. SPGB demonstrated superior analgesic-sparing effects [RR=0.45 (0.33, 0.62)] and surgical field improvement [SMD=-0.87 (-1.18, -0.57)], while IOB/ITNB better reduced postoperative nausea and vomiting (PONV) [RR=0.46 (0.31, 0.68)] and recovery time [MD=-40.86 (-61.48, -20.24) min]. Both techniques showed favorable safety profiles without significant differences in adverse events. Treatment rankings confirmed procedure-specific advantages for each technique.

[CONCLUSIONS] While both techniques effectively improve perioperative outcomes, SPGB appears superior for pain control and surgical field quality, especially in the endoscopic and functional endoscopic sinus surgery procedures, whereas IOB/ITNB demonstrates advantages for PONV prevention and reduced recovery time in rhinoplasty procedures. Procedure-specific selection of nerve block technique is recommended based on surgical priorities and patient characteristics.