Lynch M T, Syverud S A, Schwab R A, Jenkins J M, Edlich R
Division of Emergency Medicine, University of Virginia Health Sciences Center, USA.
Acad Emerg Med. 1994 Nov-Dec;1(6):514-9. doi: 10.1111/j.1553-2712.1994.tb02543.x.
The infraorbital nerve block is frequently used during repair of facial lacerations; both percutaneous and intraoral approaches are used. The authors compared the two techniques for pain of administration and anesthetic effectiveness.
A prospective, randomized, single-blind, crossover study was conducted using 12 healthy volunteers, aged 25-41 years. No patient had prior experience with infraorbital nerve anesthesia, lidocaine allergy, active oral/facial infection, or previous facial fractures. Bilateral infraorbital nerve blocks were done using the intraoral technique on one side and the percutaneous technique on the other. Both techniques were used by the same investigator and were carried out with 27-gauge needles and 2.5 mL of 2% buffered lidocaine at room temperature injected over 20 seconds. The oral mucosa was topically anesthetized with viscous lidocaine for 1 minute prior to intraoral injection. The orders of the blocks and sides of the face anesthetized were randomized. Pain of injection, anesthetic efficacy (anesthesia of upper lip), time to anesthetic onset, and duration of anesthesia were evaluated.
By visual-analog pain scale scores, there was less pain by the intraoral approach, although this difference did not achieve significance (p = 0.08). Overall, nine of the 12 subjects considered the intraoral technique less painful than the percutaneous approach (p = 0.14). The intraoral approach produced upper-lip anesthesia in 12 of 12 subjects, versus nine of 12 for the percutaneous technique (p = 0.25). The duration of anesthesia was longer with the intraoral approach (1.6 +/- 0.8 hours versus 0.9 +/- 0.4 hours) than with the percutaneous approach (p = 0.04). The two techniques were similar in times to anesthetic onset.
The intraoral approach to the infraorbital nerve block after adjunctive topical anesthesia appeared at least as effective in producing upper-lip anesthesia as the percutaneous approach without adjunctive topical anesthesia. Although the volunteers subjectively preferred the intraoral approach and visual-analog pain scores were lower for this approach, these differences did not achieve statistical significance. The intraoral approach was associated with a longer duration of upper-lip anesthesia.
眶下神经阻滞常用于面部裂伤修复；采用经皮和口内两种方法。作者比较了这两种技术在给药疼痛和麻醉效果方面的差异。
对12名年龄在25至41岁的健康志愿者进行了一项前瞻性、随机、单盲、交叉研究。没有患者曾有过眶下神经麻醉经验、利多卡因过敏、活动性口腔/面部感染或既往面部骨折史。双侧眶下神经阻滞，一侧采用口内技术，另一侧采用经皮技术。两种技术均由同一名研究者操作，使用27号针头和2.5毫升2%的缓冲利多卡因，在室温下于20秒内注射完毕。在口内注射前，用粘性利多卡因对口腔黏膜进行局部麻醉1分钟。阻滞顺序和麻醉的面部侧别均随机安排。评估注射疼痛、麻醉效果（上唇麻醉）、麻醉起效时间和麻醉持续时间。
根据视觉模拟疼痛量表评分，口内法引起的疼痛较轻，尽管这种差异未达到显著水平（p = 0.08）。总体而言，12名受试者中有9名认为口内技术比经皮技术疼痛轻（p = 0.14）。口内法使12名受试者中的12名产生了上唇麻醉，而经皮技术在12名受试者中仅使9名产生了上唇麻醉（p = 0.25）。口内法的麻醉持续时间比经皮法长（1.6±0.8小时对0.9±0.4小时）（p = 0.04）。两种技术在麻醉起效时间上相似。
辅助局部麻醉后采用口内法进行眶下神经阻滞，在产生上唇麻醉方面至少与未辅助局部麻醉的经皮法同样有效。尽管志愿者主观上更喜欢口内法，且该方法的视觉模拟疼痛评分较低，但这些差异未达到统计学意义。口内法与更长的上唇麻醉持续时间相关。
