Mariano Edward R, Watson Deborah, Loland Vanessa J, Chu Larry F, Cheng Gloria S, Mehta Sachin H, Maldonado Rosalita C, Ilfeld Brian M
Department of Anesthesiology, University of California, San Diego, CA 92103-8770, USA.
Can J Anaesth. 2009 Aug;56(8):584-9. doi: 10.1007/s12630-009-9119-5. Epub 2009 May 28.
While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery.
At a tertiary care university hospital, healthy adult subjects scheduled for outpatient nasal surgery were randomly assigned to receive bilateral infraorbital injections with either 0.5% bupivacaine (Group IOB) or normal saline (Group NS) using an intraoral technique immediately following induction of general anesthesia. All subjects underwent a standardized general anesthetic regimen and were transported to the recovery room following tracheal extubation. The primary outcome was the duration of recovery (minutes) from recovery room admission until actual discharge to home. Secondary outcomes included average and worst pain scores, nausea and vomiting, and supplemental opioid requirements.
Forty patients were enrolled. A statistically significant difference in mean [SD] recovery room duration was not observed between Groups IOB and NS (131 [61] min vs 133 [58] min, respectively; P = 0.77). Subjects in Group IOB did experience a reduction in average pain on a 0-100 mm scale (mean [95% confidence interval]) compared to Group NS (-11 [-21 to 0], P = 0.047), but no other comparison of secondary outcomes was statistically significant.
When added to a standardized general anesthetic, bilateral IOB do not decrease actual time to discharge following outpatient nasal surgery despite a beneficial effect on postoperative pain.
虽然眶下神经阻滞已被证明对小儿鼻整形和面部整形手术有镇痛效果，但迄今为止尚无研究探讨这种区域麻醉技术对成人术后恢复的影响。我们设计了这项研究，以检验眶下神经阻滞联合标准化全身麻醉可缩短门诊鼻部手术后恢复时间的假设。
在一家三级医疗大学医院，计划进行门诊鼻部手术的健康成年受试者在全身麻醉诱导后立即采用口内技术随机分配接受双侧眶下注射0.5%布比卡因（IOB组）或生理盐水（NS组）。所有受试者均接受标准化全身麻醉方案，并在气管拔管后被送往恢复室。主要结局是从进入恢复室到实际出院回家的恢复时间（分钟）。次要结局包括平均和最严重疼痛评分、恶心和呕吐以及补充阿片类药物的需求。
共纳入40例患者。IOB组和NS组之间在平均[标准差]恢复室停留时间上未观察到统计学显著差异（分别为131[61]分钟和133[58]分钟；P = 0.77）。与NS组相比，IOB组患者在0-100毫米量表上的平均疼痛有所减轻（平均值[95%置信区间]）（-11[-21至0]，P = 0.047），但其他次要结局的比较均无统计学显著性。
在标准化全身麻醉基础上增加双侧眶下神经阻滞，尽管对术后疼痛有有益影响，但并不能缩短门诊鼻部手术后的实际出院时间。
