Chen Ming-Kai, Zhao Le, Luo Wei, Luo Kai, Lin Jie, Ji Yang
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Aesthetic Plast Surg. 2025 Mar;49(5):1217-1226. doi: 10.1007/s00266-025-04671-9. Epub 2025 Jan 16.
Ultrasound-guided maxillary nerve block (UGMNB) is applied in oral and maxillofacial surgery to improve perioperative analgesia, decrease the risk of postoperative nausea and vomiting, and enhance recovery. However, the optimum volume of ropivacaine used for UGMNB is undetermined. Thus, it was hypothesized that in patients undergoing double-jaw surgery, low- and high-volume ropivacaine reduces perioperative pain with similar efficacy.
Adults undergoing double-jaw surgery were enrolled in a randomized non-inferiority trial to receive a bilateral single-injection UGMNB with 2 mL (low-volume [LV] group) or 5 mL (high-volume [HV] group) of 0.375% ropivacaine on each side. A visual analog scale (VAS) score for maxillary pain at 2 h postoperatively was taken as the primary outcome. VAS score for maxillary and mandibular pain at 2, 4, 6, 8, 12, 24, and 48 h postoperatively, hemodynamic changes intraoperatively, consumption of intraoperative opioids and sedatives, vasoactive medication use, extubation time, postoperative rescue analgesia, time to the first analgesia, postoperative nausea and vomiting and UGMNB-related complications within 48 h post-surgery were assessed as the secondary outcomes.
Sixty-four adults were included. The maxillary pain score in the LV group was not inferior to that in the HV group at 2 h postoperatively, with a non-inferiority margin of 1 (mean difference - 0.1; 95% confidence interval [CI] - 0.6 to 0.8, P = 0.414 for non-inferiority). Maxillary and mandibular pain demonstrated no difference in the measured times between groups. The incidence of postoperative nausea was significantly higher in the LV group than that in the HV group at 6-24 h (12 (37.5%) vs. 5 (15.6%), P = 0.048). Moreover, no differences in intraoperative hemodynamic parameters, medications during anesthesia, time to extubation, rescue analgesia, time to the first analgesia, and postoperative vomiting were observed. Only one patient in the LV group was observed to have maxillary nerve block-related complications.
To conclude, the efficacy of UGMNB with 2 mL of 0.375% ropivacaine has the same efficacy as the 5 mL drug in reducing perioperative pain in patients undergoing double-jaw surgery.
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超声引导下上颌神经阻滞（UGMNB）应用于口腔颌面外科手术，以改善围手术期镇痛，降低术后恶心呕吐风险，并促进恢复。然而，用于UGMNB的罗哌卡因最佳剂量尚未确定。因此，有假设认为，在接受双颌手术的患者中，低剂量和高剂量罗哌卡因减轻围手术期疼痛的效果相似。
将接受双颌手术的成年人纳入一项随机非劣效性试验，每侧接受2 mL（低剂量组[LV]）或5 mL（高剂量组[HV]）0.375%罗哌卡因的双侧单次注射UGMNB。将术后2小时上颌疼痛的视觉模拟量表（VAS）评分作为主要结局。将术后2、4、6、8、12、24和48小时上颌和下颌疼痛的VAS评分、术中血流动力学变化、术中阿片类药物和镇静剂的消耗量、血管活性药物的使用、拔管时间、术后补救镇痛、首次镇痛时间、术后恶心呕吐以及术后48小时内与UGMNB相关的并发症作为次要结局进行评估。
纳入64名成年人。术后2小时，LV组的上颌疼痛评分不劣于HV组，非劣效界值为1（平均差值 -0.1；95%置信区间[CI] -0.6至0.8，非劣效性检验P = 0.414）。上颌和下颌疼痛在各测量时间点两组间无差异。LV组术后6 - 24小时恶心发生率显著高于HV组（12例（37.5%）对5例（15.6%），P = 0.048）。此外，术中血流动力学参数、麻醉期间用药、拔管时间、补救镇痛、首次镇痛时间和术后呕吐方面未观察到差异。LV组仅1例患者出现与上颌神经阻滞相关的并发症。
总之，在接受双颌手术的患者中，2 mL 0.375%罗哌卡因的UGMNB在减轻围手术期疼痛方面与5 mL药物具有相同疗效。
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