Baljit Singh1, Vinay Bhardwaj. 1. Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. rasvin666@rediffmail.com
Abstract
PURPOSE: Mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible. METHODS: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days. RESULTS: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted. CONCLUSIONS: Continuous mandibular nerve block with 2-4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.
PURPOSE: Mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible. METHODS: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days. RESULTS: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted. CONCLUSIONS: Continuous mandibular nerve block with 2-4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.
Authors: Jonathan F Bova; Anderson F da Cunha; Rhett W Stout; Sarindr Bhumiratana; David M Alfi; Sidney B Eisig; Gordana Vunjak-Novakovic; Mandi J Lopez Journal: J Invest Surg Date: 2014-11-13 Impact factor: 2.533