Rastogi Amit, Gyanesh Prakhar, Nisha Surbhi, Agarwal Appurva, Mishra Priya, Tiwari Akhilesh Kumar
SGPGI, Lucknow, India.
Global Hospital, Chennai, India.
J Craniomaxillofac Surg. 2014 Apr;42(3):250-4. doi: 10.1016/j.jcms.2013.05.010. Epub 2013 Jun 22.
The airway is the foremost challenge in maxillofacial surgery. The major concerns are difficulty in managing the patient's airway and sharing it between the anaesthetist and surgeons. General anaesthesia, with endotracheal intubation, is the commonly used technique for maxillofacial procedures. We assessed the efficacy and safety of a regional block with sedation technique in certain maxillofacial operations, specifically temporomandibular joint (TMJ) ankylosis and mandibular fracture cases, and compared it with conventional general anaesthesia. We compared the time to discharge from the post anaesthesia care unit (PACU) and the occurrence of side effects, as well as surgeon and patient satisfaction with the anaesthetic technique, between the two groups.
MATERIALS & METHODS: We enrolled 50 patients of ASA grade 1 or 2, aged 15-50 years, scheduled for maxillofacial surgery (mandibular fracture or TMJ ankylosis). The patients were divided into two groups of 25 each, to receive sedation with a regional block with the use of a peripheral nerve stimulator in group I and general anaesthesia in group II. We observed haemodynamic parameters, intraoperative and postoperative complications and the amount of surgical bleeding in the two groups. Total anaesthesia time, patient and surgeon satisfaction, time to rescue analgesia, the number of rescue doses required, and the time to discharge from the PACU were compared.
The groups were comparable with respect to demographic profile, intraoperative haemodynamic parameters, surgical time, and amount of blood loss. Postoperative pain was assessed using the visual analogue score (VAS). Patients in group I had lower VAS scores after surgery and remained pain-free for longer than those in group II. The mean pain-free interval in group I was 159.12 ± 43.95 min and in group II was 60.36 ± 19.77 min (p < 0.005). Patients in group I required lower doses of rescue analgesia than those undergoing the surgery under general anaesthesia (p < 0.005). Patients receiving regional blocks also had fewer episodes of postoperative nausea and vomiting (p = 0.005). These results led to earlier discharge of patients in group I from the PACU.
Regional block with sedation is a safe alternative technique for patients undergoing surgery for mandible fracture or TMJ ankylosis, with clear advantages over general anaesthesia.
气道问题是颌面外科手术面临的首要挑战。主要担忧在于患者气道管理困难以及麻醉医生和外科医生之间的气道共享问题。全身麻醉联合气管插管是颌面外科手术常用的技术。我们评估了区域阻滞联合镇静技术在某些颌面手术（特别是颞下颌关节强直和下颌骨骨折病例）中的有效性和安全性，并将其与传统全身麻醉进行比较。我们比较了两组患者从麻醉后恢复室（PACU）出院的时间、副作用的发生情况以及外科医生和患者对麻醉技术的满意度。
我们纳入了50例年龄在15 - 50岁、ASA分级为1或2级、计划进行颌面外科手术（下颌骨骨折或颞下颌关节强直）的患者。将患者分为两组，每组25例，第一组采用外周神经刺激器辅助区域阻滞联合镇静，第二组采用全身麻醉。我们观察了两组患者的血流动力学参数、术中和术后并发症以及手术出血量。比较了两组的总麻醉时间、患者和外科医生的满意度、补救镇痛时间、所需补救剂量的数量以及从PACU出院的时间。
两组在人口统计学特征、术中血流动力学参数、手术时间和失血量方面具有可比性。采用视觉模拟评分（VAS）评估术后疼痛。第一组患者术后VAS评分较低，且无痛时间比第二组长。第一组的平均无痛间隔时间为159.12±43.95分钟，第二组为60.36±19.77分钟（p<0.005）。第一组患者所需的补救镇痛剂量低于接受全身麻醉手术的患者（p<0.005）。接受区域阻滞的患者术后恶心呕吐发作次数也较少（p = 0.005）。这些结果使得第一组患者能更早从PACU出院。
区域阻滞联合镇静对于接受下颌骨骨折或颞下颌关节强直手术的患者是一种安全的替代技术，相较于全身麻醉具有明显优势。
