(737): Continuous regional anesthesia of maxillary nerve: Clinical study of a new lateral approach to pterygopalatine fossa

Abstract

The aim of the study was to assess the feasibility of continuous maxillary nerve block (CMNB) using a new technical approach for an indwelling catheter. After obtaining informed consent, 12 patients scheduled for maxillary carcinoma surgery were included in a prospective study. Before surgery an indwelling catheter was placed in the pterygopalatine fossa using lateral supra-zygomatic approach, according to previous anatomical study. Six ml of ropivacaine 7.5 mg/ml were injected. Difficulties and time to perform CMNB, side effects and complications were noted. General anesthesia (GA) was induced and maintained with propofol and remifentanil. Postoperative analgesia was started 30 min. before the end of surgery and performed with 5 ml ropivacaine 2 mg/ml. All patients received 5 ml of ropivacaine 2 mg/ml twice a day during 48 hours. In Post Anesthesia Care Unit morphine was titrated until stable pain control was achieved. An intravenous PCA device with morphine was started and continued in surgical ward during 48 hours. Pain level was analyzed with Visual Analogic Scale (VAS). In case of uncontrolled pain (VAS>4), patients received 1gr of paracetamol IV. Before nasal packing removal on 4th postoperative day 5ml of ropivacaine 7.5 mg/ml was injected into the catheter, GA was performed only if necessary. Results were compared with historic control group having maxillary carcinoma surgery without CMNB. Time to perform CMNB was 5min0.9 (meanSD), neither difficulty nor complication was noted. Eleven CMNB were achieved on first attempt. Remifentanil and paracetamol consumptions were significantly decreased in CMNB group. First paracetamol injection was significantly delayed in CMNB group. Only one patient in CMNB group needed GA for nasal packing removal because of early catheter removal. In conclusion CMNB via supra-zygomatic approach is easy and safe. CMNB improves per and post-operative analgesia and avoids GA for nasal packing removal. The aim of the study was to assess the feasibility of continuous maxillary nerve block (CMNB) using a new technical approach for an indwelling catheter. After obtaining informed consent, 12 patients scheduled for maxillary carcinoma surgery were included in a prospective study. Before surgery an indwelling catheter was placed in the pterygopalatine fossa using lateral supra-zygomatic approach, according to previous anatomical study. Six ml of ropivacaine 7.5 mg/ml were injected. Difficulties and time to perform CMNB, side effects and complications were noted. General anesthesia (GA) was induced and maintained with propofol and remifentanil. Postoperative analgesia was started 30 min. before the end of surgery and performed with 5 ml ropivacaine 2 mg/ml. All patients received 5 ml of ropivacaine 2 mg/ml twice a day during 48 hours. In Post Anesthesia Care Unit morphine was titrated until stable pain control was achieved. An intravenous PCA device with morphine was started and continued in surgical ward during 48 hours. Pain level was analyzed with Visual Analogic Scale (VAS). In case of uncontrolled pain (VAS>4), patients received 1gr of paracetamol IV. Before nasal packing removal on 4th postoperative day 5ml of ropivacaine 7.5 mg/ml was injected into the catheter, GA was performed only if necessary. Results were compared with historic control group having maxillary carcinoma surgery without CMNB. Time to perform CMNB was 5min0.9 (meanSD), neither difficulty nor complication was noted. Eleven CMNB were achieved on first attempt. Remifentanil and paracetamol consumptions were significantly decreased in CMNB group. First paracetamol injection was significantly delayed in CMNB group. Only one patient in CMNB group needed GA for nasal packing removal because of early catheter removal. In conclusion CMNB via supra-zygomatic approach is easy and safe. CMNB improves per and post-operative analgesia and avoids GA for nasal packing removal.