A Randomized Observer-Blinded Controlled Trial to Compare Pre-Emptive with Postoperative Ultrasound-Guided Mandibular Nerve Block for Postoperative Analgesia in Mandibular Fracture Surgeries
Received 12 November 2020
Accepted for publication 20 January 2021
Published 10 February 2021 Volume 2021:14 Pages 13—20
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Stefan Wirz
Rajagopalan Venkatraman, Kandhan Karthik, Cherian Belinda, Ramamurthy Balaji
Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, Tamilnadu, 603203, India
Correspondence: Rajagopalan Venkatraman
Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Potheri, 603203, Tamilnadu, India
Tel +91 9894581455
Background and Aims: Ultrasound-guided (UG) mandibular nerve block is effective for providing postoperative analgesia in mandibular fracture surgeries. The pre-emptive nerve blockade prolongs the duration of postoperative analgesia and reduces the consumption of intraoperative opioids. The aim of this prospective, randomized, single-blinded study was to compare the efficacy of pre-emptive and postoperative UG mandibular nerve block for postoperative analgesia in mandibular fracture surgeries.
Methods: Sixty patients scheduled for unilateral mandibular fracture surgeries were randomly divided into two groups by computer-generated random numbers and sealed envelope method: Group A received UG mandibular nerve block before surgical incision and group B received after surgery with ropivacaine 0.5% 10mL. The second anesthesiologist, who was blinded to the group involved, monitored the patient. The patients as well as the statistician were also blinded. The patients were started on patient-controlled analgesia (PCA) morphine with bolus 1mg and a lockout interval of 10min. The morphine consumption for 24h was recorded. The pain was assessed by the VAS score. The additional intraoperative fentanyl consumption and time for a request for rescue analgesic were recorded.
Results: The total morphine consumption was reduced in group A (4.566± 0.717mg) than group B (5.93± 0.876mg) with a p-value of < 0.0001. The time for a request for rescue analgesic was also prolonged in group A (794.08± 89.561min) than group B (505.333± 3.159min). In group A, only four patients required an additional dose of fentanyl as against 11 patients in group B. The heart rate was also lower in group A 30min after the administration of the block and persisted for two hours intraoperatively.
Conclusion: Pre-emptive ultrasound-guided mandibular nerve block reduces morphine consumption, prolongs the time for a request for rescue analgesic, reduces intraoperative fentanyl consumption, provides better control of intraoperative heart rate, and better pain scores postoperatively when compared to the postoperative mandibular nerve block.
Keywords: mandibular fracture, mandibular nerve, postoperative pain, ultrasound-guided, visual analog scale
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