Abstract
Background: Pain severity after ear surgery is usually at its worst during the first few hours after surgery. The greater auricular nerve is the major sensory branch of the cervical plexus and is readily amenable to blockade as it lies superficially passing over the sternocleidomastoid muscle. Dexamethasone as an adjuvant is known to prolong analgesia Aims and Objectives To compare the efficacy of combination of bupivacaine 0.25% (9.5ml) with dexamethasone 2mg (0.5ml) versus bupivacaine 0.25% (9.5ml) with normal saline (0.5ml) in greater auricular nerve block for Duration of analgesia and Requirement of rescue analgesia postoperatively. Methodology: Prospective double blind randomized controlled trial .50 patients aged 18-65 years, ASA status I / II posted for mastoid surgery were randomly allocated into two groups. Both groups received routine general anaesthesia. Intra operatively, analgesia was maintained with boluses of IV fentanyl 25µg each if required. At the end of surgery, just before extubation the nerve was identified using anatomical landmarks and blocked blindly with the drugs chosen depending on the group. The patients were extubated after complete reversal of neuromuscular blockade. Results: Demographic data and type of surgery were similar in both the groups. There was a significant difference for duration of analgesia between the two groups (p<0.01). Conclusion: Dexamethasone as an adjuvant to bupivacaine in greater auricular nerve block significantly increases the duration of analgesia and reduces the need for rescue analgesics without any complications.
Highlights
Regional anaesthetic techniques score over systemic medication by abolishing primary hyperalgesia due to tissue damage blocking central sensitization which prevents secondary hyperalgesia altogether.[1]
Dexamethasone as an adjuvant to bupivacaine in greater auricular nerve block significantly increases the duration of analgesia and reduces the need for postoperative analgesics without any complications
We evaluated requirement of rescue analgesia postoperatively and complications of block, if any
Summary
Regional anaesthetic techniques score over systemic medication by abolishing primary hyperalgesia due to tissue damage blocking central sensitization which prevents secondary hyperalgesia altogether.[1] The greater auricular nerve block is one such simple technique known to provide analgesia in tympano-mastoid surgery. The greater auricular nerve (GAN) is a major sensory branch of the cervical plexus. The great auricular nerve provides sensory innervations for both surfaces of the external ear, areas above and on the posterior surface of the auricle and most of the skin covering the mastoid process and parotid gland.[1,2,3] The GAN is readily amenable to local anaesthetic blockade as it lies in a superficial location passing over the sternocleidomastoid muscle. The greater auricular nerve is the major sensory branch of the cervical plexus and is readily amenable to blockade as it lies superficially passing over the sternocleidomastoid muscle.
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