Tarigopula Vivek, Mandal Swarnendu, Rohith Gorrepati, Dheeroo Dheeraj Kumar, Das Manoj Kumar, Tripathy Sambit, Barik Kalandi, Nayak Prasant
Department of Urology and Renal Transplant, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Urology and Renal Transplant, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
Indian J Urol. 2025 Jan-Mar;41(1):45-50. doi: 10.4103/iju.iju_167_24. Epub 2025 Jan 1.
Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake.
A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals > 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration.
After randomization ( = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; ≤ 0.001) and solid diet (median 2 vs. 3 days; = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; = 0.002).
Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.
术后即刻颊黏膜移植物（BMG）供区疼痛很常见，会延迟经口进食的恢复。本研究比较了在下牙槽神经阻滞联合颊神经阻滞（IANB + BNB）与安慰剂给药后，恢复无痛固体和液体饮食的时间以及供区术后疼痛评分。我们假设该干预措施可减轻疼痛并有助于早期进食。
于2022年9月至2023年8月进行了一项单中心、安慰剂对照、双盲随机对照试验（CTRI）。纳入所有接受BMG采集的18岁以上个体。排除有BMG采集禁忌证和糖尿病的患者。此外，需要额外舌/唇移植物、双侧BMG或既往有BMG采集史的患者也被排除。使用含利多卡因、布比卡因和地塞米松的10 ml混合物进行IANB + BNB，而对照组给予生理盐水。两组均接受黏膜下局部麻醉浸润。
随机分组后（每组 = 28例），接受IANB + BNB的患者恢复无痛液体饮食（中位数1天对2天；≤ 0.001）和固体饮食（中位数2天对3天； = 0.001）的时间比接受安慰剂的患者早1天。在干预组中，供区视觉模拟量表评分在术后2至48小时较低，对乙酰氨基酚需求量减少（中位数7 g对9 g； = 0.001），因突破性疼痛需要使用阿片类药物的情况较少（14.4%对53.3%； = 0.002）。
接受IANB + BNB的患者术后更快恢复无痛饮食，报告的疼痛评分较低，术后镇痛需求也较少。
