Tan Ferdinand Frederik Som Ling, Schiere Sjouke, Reidinga Auke C, Wit Fennie, Veldman Peter Hjm
Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands.
Local Reg Anesth. 2015 May 14;8:11-4. doi: 10.2147/LRA.S63246. eCollection 2015.
Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block.
Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion.
Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day.
A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.
区域麻醉因能提供出色的术后镇痛效果而越来越受到麻醉医生的青睐。然而，作为不首选全身麻醉的高危患者的唯一麻醉技术，一些区域麻醉的可能性可能很容易被忽视。通过介绍两例患有严重合并症的高龄患者，我们希望重新引起对颏神经阻滞的关注，将其作为全身麻醉的一种安全替代方法，并实现这种简单神经阻滞的更广泛应用。
两名高龄男性患者（分别为84岁和91岁）均因下唇溃疡性病变计划接受手术切除。由于他们存在严重的合并症且身体更加虚弱，双侧颏神经阻滞被认为优于全身麻醉。对于有肺叶切除病史的84岁患者，该手术可以在沙滩椅位安全进行，以防止肺不张并优化单肺的通气/灌注比，这是额外的优势。颏神经阻滞在口腔内以盲法进行，先翻起嘴唇并确定下尖牙，然后将连接有23号针头的5毫升注射器刺入颊黏膜，直至接近颏孔，在该处注射2毫升含1:100000肾上腺素的2%利多卡因。另一侧以类似方式麻醉。
两名患者均在双侧颏神经阻滞下顺利完成手术，并于同日出院。
颏神经阻滞是一种用于下唇手术的易于实施的区域麻醉技术。该技术在高龄、虚弱患者中可能特别有利。
