Is Inferior Alveolar Nerve Block Beneficial in Fracture Mandibular Surgeries? A Randomised Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- bilateral inferior alveolar nerve block
- Conditions
- Anesthesia
- Sponsor
- Ain Shams University
- Enrollment
- 46
- Locations
- 1
- Primary Endpoint
- The time of the first dose of fentanyl rescue analgesia intraoperative
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The aim of the study is to assess the efficacy of adding of pre-emptive inferior alveolar nerve block compared to the conventional systemic intravenous analgesia in controlling perioperative pain in fracture mandibular surgeries.
Detailed Description
Opioid drug administration is a common technique to reduce pain from surgical trauma. However, the use of large doses of opioid drugs during and after surgery can be associated with an increased incidence of multiple side effects such as; ventilatory depression, sedation, nausea, vomiting, pruritus, difficult voiding and ileus. In maxillofacial surgeries in which patients often receive maxillomandibular fixation these side effects are troublesome to the patient and at worst case scenario can cause a life-threatening complications. Ventilatory depression and vomiting are the most serious side effects especially in early postoperative hours. Various methods have been proposed to minimize these side effects. Nerve block with long-acting local anesthesia is a proposed technique in this regard. In maxillofacial operations, bupivacaine is a highly efficient long-acting local anesthetic and has been used as a safe local anesthetic for neuroanalgesia after cleft lip operation or third molar surgery alone or in combination with low-power laser and diclofenac. Inferior alveolar nerve block is considered as gold standard for sensory block of the hemi mandible. It can provide adequate anesthesia and analgesia for one side of the mandibular teeth and gingival mucosa, the body and inferior ramus of the mandible, the anterior two-thirds of the tongue and floor of the mouth cavity. The inferior alveolar nerve (IAN) block is a widely used regional anaesthetic nerve block for the mandible. The most commonly used technique for IAN block is called the direct approach which include inserting the needle into the pterygomandibular raphae by penetrating the buccinators muscle. Once in this space, the aim is to inject the local anaesthetic solution besides the inferior alveolar nerve before it enters the mandibular foramen.
Investigators
mohamed atef
assistant lecturer of anesthesia
Ain Shams University
Eligibility Criteria
Inclusion Criteria
- •Age group: 18 - 65 years old.
- •American Society of Anesthesiologists (ASA) Physical Status Class I to III
- •Scheduled for fracture mandible fixation.
Exclusion Criteria
- •Refusing to participate in the study.
- •History of allergy to the medications used in the study.
- •Contraindications to regional anesthesia (including coagulopathy and local infection).
- •Psychiatric disorders.
Arms & Interventions
Study group (IAN block group)
patients will receive bilateral inferior alveolar nerve block. 23 patients
Intervention: bilateral inferior alveolar nerve block
control group
patients will not receive the block and will receive intravenous multimodal analgesia according to standard protocol. 23 patients
Intervention: Ketorolac and fentanyl
Outcomes
Primary Outcomes
The time of the first dose of fentanyl rescue analgesia intraoperative
Time Frame: Throughout the surgery
guided by hemodynamic changes
Total amount of additional intraoperative fentanyl rescue analgesia
Time Frame: Throughout the surgery
guided by hemodynamic changes
The time from recovery to the first dose pethidine rescue analgesic
Time Frame: 24 hours postoperatively
guided by visual analogue scale.
Total amount of pethidine postoperative rescue analgesic
Time Frame: 24 hours postoperatively
guided by visual analogue scale.
Secondary Outcomes
- Incidence of complications related to the block(24 hours postoperatively)