Sphenopalatine Ganglion Block for Pain Relief After Pediatric Adenotonsillectomy

Tonsillectomy, with or without adenoidectomy, is one of the most common surgicalprocedures performed in children. Despite being frequent, it is associated withsignificant postoperative morbidity, particularly severe pain, postoperative nausea andvomiting, and bleeding. Current pain management relies heavily on opioids andnonsteroidal anti‐inflammatory drugs, both of which carry risks in this population:opioids are associated with respiratory depression, of particular concern in childrenwith obstructive sleep apnea, and increased postoperative nausea and vomiting, whileNSAIDs raise concerns about postoperative bleeding.The sphenopalatine ganglion block is a simple, minimally invasive technique that hasshown promising analgesic effects in adults undergoing sinonasal and otherotorhinolaryngologic surgeries, with evidence suggesting reduced postoperative pain,reduced opioid consumption, and reduced intraoperative bleeding. However, evidencesupporting the safe and effective use of sphenopalatine ganglion block specifically inchildren undergoing adenotonsillectomy remains limited.This study is designed to evaluate whether sphenopalatine ganglion block reducespostoperative pain compared with a sham block in children undergoing tonsillectomy ortonsillotomy, with or without adenoidectomy, for indications such as obstructive sleepapnea or recurrent tonsillitis.Eligible participants will be randomized 1:1 using a web‐based block randomization systemmanaged by a person external to the clinical team. An unblinded team member, nototherwise involved in the child's anesthetic or surgical care, will prepare the studymedication (ropivacaine or saline) according to the randomization result. All othermembers of the clinical and research team, as well as the participants and theirfamilies, will remain blinded to group allocation.Based on an alpha of 0.05, a statistical power of 95%, and a medium effect size (Cramer'sV = 0.3 for the chi‐square test; d = 0.6 for the Mann‐Whitney test), a total sample sizeof 145 participants was determined to provide adequate power for both the primary and keysecondary outcomes.This is the first randomized clinical trial to evaluate the effect of sphenopalatineganglion block specifically on postoperative pain control after adenotonsillectomy inchildren, and its findings are intended to help inform evidence‐based perioperative painmanagement guidelines for this common pediatric surgical population.