Infraorbital–Infratrochlear Versus Transnasal Sphenopalatine Ganglion Block for Septorhinoplasty: A Prospective, Randomized, Double-Blind, Clinical Trial

Background/Objectives: Regional anesthesia techniques are increasingly being incorporated into multimodal analgesia for septorhinoplasty. This study compared the postoperative analgesic efficacy and recovery profiles of infraorbital–infratrochlear (ION–ITN) nerve block and transnasal sphenopalatine ganglion (SPG) block techniques. Methods: In this prospective, randomized, double-blind trial, 93 patients undergoing septorhinoplasty received bilateral ION–ITN block (n = 45) or transnasal SPG block (n = 48). The primary outcome was postoperative pain assessed using the Numerical Rating Scale (NRS). Peak postoperative NRS scores at the predefined assessment intervals were evaluated with a linear mixed-effects model adjusted for relevant covariates. Continuous variables are presented as medians (first quartile–third quartile [Q1–Q3]), and categorical variables as numbers (percentages). Secondary outcomes included emergence agitation (Riker Sedation–Agitation Scale (RSAS)), rescue tramadol use, patient satisfaction, and adverse events. Results: Pain scores decreased significantly over time in both groups (p < 0.001). No significant group effect was observed (p = 0.726), and adjusted between-group differences were not significant at any postoperative interval (all p > 0.05). Although the group-by-time interaction showed a trend toward statistical significance (p = 0.053), no meaningful differences in postoperative pain trajectories were observed between the two groups. Median RSAS scores were lower in the SPG group (3 [2,3,4] vs. 4 [3,4], p = 0.04), whereas emergence agitation incidence, tramadol use, patient satisfaction, and adverse events were similar. Conclusions: Within the multimodal analgesic regimen, no statistically significant differences in postoperative pain outcomes were detected between ION–ITN and transnasal SPG block. Because this study was not designed as an equivalence or non-inferiority trial, these findings should be interpreted as an absence of detected differences rather than proof of equivalent analgesic efficacy. Although SPG block was associated with lower agitation scores, this finding suggests reduced agitation severity rather than superior overall analgesic efficacy.