Ultrasound-guided trigeminal nerve block and its comparison with conventional analgesics in patients undergoing faciomaxillary surgery: Randomised control trial
Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Poonam Kumari, Sailesh Kumar Mukul, Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Poonam Kumari, Sailesh Kumar Mukul
Abstract
Background and aims: Ultrasound (USG)-guided injection in pterygopalatine fossa is an indirect approach to block the trigeminal nerve. Trigeminal nerve block for maxillofacial surgeries may provide preemptive analgesia, reduce opioid consumption and opioid-related adverse effects.
Methods: In this randomised, prospective double-blind study, 60 American Society of Anesthesiologists I/II patients, within the age group of 18-60 years scheduled for faciomaxillary surgery (fracture/pathological lesion of maxilla or mandible and cleft lip), were recruited. The patients were allocated in either of the two groups: group I: general anaesthesia (FENT group) and group II: general anaesthesia + trigeminal nerve (TNB group). Perioperative opioid consumption and postoperative pain scores were recorded. Any adverse effects like respiratory depression and nausea were also looked for.
Results: Patients in group II required less intraoperative fentanyl top ups (1.17 ± 0.53 vs 2.70 ± 0.53) (P < 0.05). Postoperative opioid consumption was also less in this group (0.93 ± 0.69 vs 3.53 ± 0.68) (P < 0.05).
Conclusion: USG-guided TNB reduces perioperative opioid consumption in patients undergoing faciomaxillary surgery with better patient pain scores.
Keywords: Analgesia; opioid; pterygopalatine fossa; trigeminal nerve block.
Conflict of interest statement
There are no conflicts of interest.
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References
- Plantevin F, Pascal J, Morel J, Roussier M, Charier D, Prades JM, et al. Effect of mandibular nerve block on postoperative analgesia in patients undergoing oropharyngeal carcinoma surgery under general anaesthesia. Br J Anaes. 2007;5:708–12.
- Nader A, Kendall MC, De Oliveria GS, Chen JQ, Vanderby B, Rosenow JM, et al. Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: An effective treatment for trigeminal neuralgia and atypical facial pain. Pain Physician. 2013;16:E537–45.
- Roussier M, Mahul P, Pascal J, Baylot D, Prades JM, Auboyer C, et al. Patient-controlled cervical epidural fentanyl compared with patient-controlled i.v.fentanyl for pain after pharyngolaryngeal surgery. Br J Anaesth. 2006;96:492–6.
- Nguyen A, Girard F, Boudreault D, Fugère F, Ruel M, Moumdjian R, et al. Scalp nerve blocks decrease the severity of pain after craniotomy. Anesth Analg. 2001;93:1272–6.
- Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement. Reg Anesth Pain Med. 2002;27:139–44.
- Umino M, Kohase H, Ideguchi S, Sakurai N. Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve. Clin J Pain. 2002;18:196–9.
- Singh B, Bhardwaj V. Continuous mandibular nerve block for pain relief. A report of two cases. Can J Anaesth. 2002;49:951–3.
- Kohase H, Umino M, Shibaji T, Suzuki N. Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain. Acta Anaesthesiol Scand. 2004;48:382–3.
- Spinner D, Kirschner JS. Accuracy of ultrasound-guided superficial trigeminal nerve blocks using methylene blue in cadavers. Pain Med. 2012;13:1469–73.
- Nader A, Schittek H, Kendall MC. Lateral pterygoid muscle and maxillary artery are key anatomical landmarks for ultrasound-guided trigeminal nerve block. Anaesthesiology. 2013;118:957.
- Nader A, Kendall M. Dexamethasone versus triamcinolone side effects for ultrasound-guided trigeminal nerve block for the treatment of refractory typical or atypical facial pain. J Pain. 2016;17:S72.
- Van Lancker P, Abeloos JV, De Clercq CA, Mommaerts MY. The effect of mandibular nerve block on opioid consumption, nausea and vomiting in bilateral mandibular osteotomies. Acta Anaesthesiol Belg. 2003;54:223–6.
Source: PubMed