Bilateral Maxillary Nerve Block Research Articles

Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study.

To assess the use of adrenaline (0.00198%) in a bilateral maxillary nerve block to reduce intraoperative hemorrhage in dogs undergoing staphylectomy for the treatment of brachycephalic obstructive airway syndrome (BOAS). Prospective, randomized, double-blinded controlled study. A total of 32 client owned, clinically affected dogs undergoing a cut and sew sharp staphylectomy for treatment of BOAS. A total of 16 dogs randomly assigned to adrenaline (A) group and 16 to no-adrenaline (NA) group. A bilateral maxillary nerve block was performed in all dogs prior to staphylectomy using lidocaine alone (group NA) or a combination of lidocaine and adrenaline (group A). Total hemorrhage was measured by weighing cotton-tipped applicators and swabs used on precision scales. In addition, a semi-quantitative hemorrhage score (1-5) was determined. Dogs were monitored for intraoperative hemodynamic stability during the procedure. Total hemorrhage was significantly (p = .013) lower in group A compared with group NA. The median semi-quantitative hemorrhage score was significantly lower for group A (p = .029) compared with group NA. No significant adverse effects were noted due to adrenaline usage. This study demonstrated that the use of adrenaline in a bilateral maxillary nerve block results in significantly lower intraoperative hemorrhage during cut and sew sharp staphylectomy and appeared safe to use. Potential clinical advantages include improved visualization, prevention of unnecessary blood loss and reduction in risk of blood aspiration.

Unilateral exophthalmos in a dog following bilateral maxillary nerve block for rhinoscopy

AbstractLocal anaesthetic techniques are utilised to provide analgesia and anaesthesia during rhinoscopy (and biopsy) in small animals. This report describes the incidence and management of exophthalmos in a 1‐year‐old, male, neutered whippet as a consequence of a retrobulbar haematoma, following inadvertent vessel puncture while performing a maxillary nerve block. The patient recovered fully without further complications following conservative management.

Opioid-free anaesthesia for the surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome in five dogs

Opioid-free anaesthesia is currently becoming more popular in human medicine, as it provides multimodal analgesia, affecting multiple nociceptive pathways without the use of opioids, in order to minimise opioid-related side effects. This article presents the cases of five dogs undergoing surgical correction of abnormalities associated with brachycephalic obstructive airway syndrome, all of whom received opioid-free anaesthesia for surgery. All dogs received a bilateral maxillary nerve block with bupivacaine 0.5% and a combination of non-opioid analgesic drugs. Buprenorphine was allowed during the postoperative period, based on pain assessment. Three out of five dogs received buprenorphine 6–7 hours after the nerve block was performed. Opioid-free anaesthesia provided adequate conditions for surgery and no adverse effects were reported. Prospective controlled studies comparing opioid-free anaesthesia with opioid-based techniques are required to elucidate whether or not opioid-free anaesthesia confers objective advantages.

Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study.

BackgroundCleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia.MethodsSixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine.ResultsFace, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications.ConclusionsLevobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

A new approach for peri‐operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block

Congenital cleft palate (CP) is a common and painful surgical procedure in infants. CP repair is associated with the risk of postoperative airway obstruction, which may be increased with administration of opioids, often needed for analgesia. No described regional anesthesia technique can provide adequate pain control following CP repair in infants. The primary aim of this prospective and descriptive study was to observe the effectiveness of bilateral maxillary nerve blocks (BMB) using a suprazygomatic approach on pain relief and consumption of rescue analgesics following CP repair in infants. Analgesic consumption was compared to retrospective data. Complications related to this new technique in infants were also reviewed. The landmarks and measurements recently defined in a three-dimensional study using computed tomography in infants were used. After general anesthesia, a BMB was performed bilaterally with 0.15 ml x kg(-1) 0.2% ropivacaine in infants scheduled for CP repair. Postoperative analgesia, administration of rescue analgesics, adverse effects, and time to feed were recorded in the 48-h period following surgery and compared to retrospective data. Thirty-three children, mean age 5 +/- 1.8 months and weight 8.3 +/- 1.2 kg, were studied. Eighteen patients out of 33 (55%) did not require additional opioids intra-operatively, vs two out of 20 (10%) without block. None needed morphine postoperatively, and intravenous nalbuphine was required in only six children (18%), vs 16 (80%) without block. Median time to feed was 8 h (range 2-24 h), vs 13 h (4-25) without block. No technical failure or complication related to the BMB was reported. BMB using a suprazygomatic approach seems to improve pain relief, to decrease peri-operative consumption of opioids, and to favor early feeding resumption after CP repair in infants.