超声引导下颌神经口外阻滞与下颌第三磨牙牙槽窝内传导阻滞在下颌第三磨牙拔除术后镇痛效果的临床前瞻性研究

Analgesic effect of ultrasound-guided extraoral mandibular nerve block compared to intraoral conductive block of the inferior alveolar nerve after lower third molar alveolectomy: a clinical prospective study.

机构信息

Department of Anesthesiology, Reanimatology, and Intensive Medicine, Varazdin General Hospital, 1 I. Mestrovica Street, Varazdin, 42000, Croatia.

Clinic of Anesthesiology, Reanimatology, Intensive Care and Pain Therapy, University Clinical Hospital Centre Zagreb, Zagreb, Croatia.

出版信息

BMC Oral Health. 2024 Sep 4;24(1):1041. doi: 10.1186/s12903-024-04787-5.

DOI:10.1186/s12903-024-04787-5

PMID:39232703

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11375996/

Abstract

BACKGROUND

The analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block.

METHODS

Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic.

RESULTS

The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia.

CONCLUSION

US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery.

CLINICAL TRIAL REGISTRATION

https://classic.

CLINICALTRIALS

gov/ct2/show/NCT06009302 , identification number: NCT06009302, date of registration: 18/08/2023.

摘要

背景

下第三磨牙牙槽切除术的术后镇痛基于使用非甾体抗炎药（NSAIDs），但此类药物具有显著风险，且在妊娠晚期禁用。为了减少此类手术后 NSAIDs 的使用，我们对超声（US）引导下的下颌神经口外阻滞的镇痛效果进行了量化评估。

方法

根据是否愿意接受超声引导下的下颌神经口外阻滞作为术后镇痛，将 36 名患者等分为实验组和对照组。实验组在下第三磨牙牙槽切除术前行实验性下颌神经口外阻滞，然后进行标准的口内下牙槽神经阻滞。在对照组中，患者仅接受口内下牙槽神经阻滞。所有患者均在阻滞后即刻报告疼痛程度（视觉模拟评分，VAS）。次日，患者报告无疼痛时间和使用镇痛药的情况。

结果

US 引导下的下颌神经口外阻滞可将无痛时间延长至 8 小时（对照组为 4 小时，P<0.001），并减少 NSAIDs 的使用（实验组 12 名患者需要镇痛药，对照组 17 名患者需要镇痛药，P=0.038）。实验组阻滞的疼痛程度（VAS=2）低于口内下牙槽神经阻滞（VAS=4，P=0.011）。在实验组的 18 名患者中，有 8 名患者仅通过 US 引导下的下颌神经口外阻滞即可实现充分的手术麻醉。