Singh Baljit, Bhardwaj Vinay
Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
Can J Anaesth. 2002 Nov;49(9):951-3. doi: 10.1007/BF03016881.
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.
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.
Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted.
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.
下颌神经阻滞可用于下颌骨手术。然而，术后疼痛需要使用有不良副作用的阿片类药物或非甾体抗炎药进行治疗。我们研究了在两名下颌骨骨折患者中使用导管持续注入0.25%布比卡因进行下颌神经阻滞以缓解术中及术后疼痛的可行性。
采用外侧口外入路，在两名接受全身麻醉下下颌骨骨折修复术的患者中，用18号静脉留置套管针穿刺下颌神经。拔出针头后，将一根18号硬膜外导管插入套管，然后拔出套管。将导管经皮下隧道引出至前额外侧。每12小时注入2至4毫升0.25%布比卡因，导管留置7天。
两名患者术后疼痛均得到良好缓解，术后全程无需注射或口服镇痛药。未观察到副作用。
通过导管每天两次注入2 - 4毫升0.25%布比卡因进行持续下颌神经阻滞，可使下颌骨骨折患者术后疼痛得到良好缓解。该方法可能对下颌区域其他病因引起的疼痛管理有启示作用。
