Maxillary and Mandibular Nerve Block

Mansoura University60 enrolled

Overview

Mandibular fractures are among the most common (60-70%) maxillofacial fractures observed in emergency rooms. In the closed reduction (non-surgical), the bone fragments are realigned manually or by using traction devices. The open reduction surgery of mandibular fractures should first ensure the restoration of the occlusion of the mandible to prevent postoperative malocclusion, followed by stabilization by means of rigid fixations such as plates, screws, and rigid intermaxillary blocks in order to minimise any nonunion, malunion, or delayed union of the fracture segments. These surgical procedures are associated with moderate postoperative pain, being the first 24 hours the most intense pain period. Maxillary and mandibular nerve blocks are performed in patients with refractory trigeminal neuralgia. However, there have been few studies evaluating the analgesic effects of these blocks for maxillofacial surgeries.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Analgesia

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * American Society of Anesthesiologists (ASA) I/II patients, * within the age group of 21-60 years * both sex * scheduled for elective faciomaxillary surgery Exclusion Criteria: * Pregnant or breast-feeding women * Patients with polytrauma * Patients necessitating postoperative ventilation * Oral or facial infection * Coagulopathy * Drug intake for chronic pain * Known allergy to the study drugs * Psychiatric disorder

Outcomes

Primary Outcomes

Total postoperative fentanyl rescue analgesic consumption

microgram

Time frame: first 24 hours postoperatively

Secondary Outcomes

Intraoperative heart rate (HR)

beats per minute

Time frame: each 15 minutes Intraoperative plus 1hour postoperatively and 2hours postoperatively

Intraoperative mean arterial pressure (MAP)

mmHg

Time frame: each 15 minutes Intraoperative plus 1hour postoperatively and 2hours postoperatively

10-cm visual analogue scale (VAS)

where 0 represented no pain, and 10 meant the worst possible pain

Time frame: at 0, 2, 4, 6, 8, 12, and 24 hours postoperatively

Postoperative analgesic duration

hours

Time frame: up to 24 hours (the time from ending of the nerve block till the first rescue morphine dose)

Patients' satisfaction about their analgesia

on a scale from 1 (poor), 2 (fair) to 3 (good)

Time frame: 24 hours postoperatively

Total postoperative diclofenac sodium consumption