Infraorbital Block Research Articles

Oculo Adnexal Trauma by Hook and Extraction under Infra Orbital Block: A Case Report from the Thies Regional Hospital Center

Ocular and or adnexal trauma is a frequent reason for consultation in rural areas. The context in which it occurs and the nature of the blunt or perforating object vary widely. The target population is heterogeneous, and the injuries sometimes alter the body image of patients, who end up adopting a fatalistic attitude. An exhaustive review of the epidemiological aspects of these injuries remains a challenge, especially in rural areas. We report a case of oculo adnexal trauma caused by a fish hook in a fisherman; extraction was performed via a cutaneous approach under the infra-orbital block.

Regional anesthesia in neonates with cleft lip and palate: Retrospective study

BackgroundOrofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. Patients/methodsOverall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. ResultsData from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. ConclusionsRegional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. Clinicaltrials.gov identifierNCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.

Effect of Infraorbital Block by Bupivacaine and Bupivacaine-Ketamine against Analgesics duration in Labioplasty patients

Labioplasty discomfort can be prevented by inhibiting the infraorbital nerve. Ketamine can be utilized as an adjuvant to lengthen the duration of analgesia in the infraorbital block when bupivacaine is used for infraorbital blocks within a relatively short period. This study aimed to assess the analgesic duration of bupivacaine and bupivacaine-ketamine on the infraorbital block in patients undergoing labioplasty, using the FLACC pain score.The research is a prospective approach, randomized, controlled clinical experiment with double-blinding. Thirty subjects, 3-12month-old children with ASA I and II status, received labioplasty surgery. Subjects were administered 1mL of each infraorbital block with 0.25% Bupivacaine and 0.25% Bupivacaine with Ketamine 0.5mg/kg BW to each group. The Paired T-test was used to compare subject characteristics, while the Independent T-test was used to compare heart rate. Chi-square (Fisher's exact) analysis revealed a significance level of p 0.005 for the FLACC value comparison. All statistical test results were examined with SPSS version 25.0. In the Bupivacaine group, there was an increase in mild pain within 4-5hours (7:46.7%); by 6 hours, there was an increase in mild pain in all 15 participants. At eight hours, it progressed to moderate pain (7:46.7%) with 496 minutes of analgesia and light pain (8:53.7%). The individuals in the Bupivacaine-Ketamine group had pain between 5-8 hours. Six patients (40%) with a pain-free analgesia duration of 1.440 minutes and nine (60%) with a minor pain status had FLACC values 4 during 24-hour observations.Bupivacaine and Bupivacaine-Ketamine have no side effects and no change in heart rate. Combining Bupivacaine with Ketamine has a more prolonged postoperative analgesic effect (24 hours) than the bupivacaine group in the infraorbital block in labioplasty patients (8 hours).

The pharmacokinetics of levobupivacaine 0.5% after infraorbital or inferior alveolar block in anesthetized dogs.

Data are lacking on the pharmacokinetic profile and safety of levobupivacaine (LB) used for regional anesthesia of the maxilla and mandibles in dogs. Infraorbital block (n = 10), inferior alveolar block (n = 10) or both infraorbital and inferior alveolar blocks (n = 10) were administered to dogs undergoing dental surgery under isoflurane anesthesia. The dose of LB was calculated as 0.11 ml/kg2/3 for the infraorbital block and 0.18 ml/kg2/3 for the inferior alveolar block. Blood samples were collected before and immediately after administration of the oral blocks, and 3, 4, 7, 12, 17, 32, 47, 62, 92, and 122 min thereafter. Quantification of LB in plasma was performed by LC-MS/MS. The results are presented as median and interquartile range. In dogs in which all four quadrants of the oral cavity were desensitized with LB, the C max was 1,335 (1,030-1,929) ng/ml, the T max was 7 (4-9.5) min, and the AUC(0 → 120) was 57,976 (44,954-96,224) ng min/ml. Plasma concentrations of LB were several times lower than the reported toxic concentrations, and no signs of cardiovascular depression or neurotoxicity were observed in any of the dogs, suggesting that the occurrence of severe adverse effects after administration of LB at the doses used in this study is unlikely.

164. Ophthalmoplegia following a cleft Le Fort 1 Osteotomy: An unlikely cause with review of the literature

Ophthalmic symptoms such as diplopia and amaurosis are rare but recognised complications of orthognathic surgery. These rare complications, are usually due to trauma or haemorrhage. We present a case of post-operative ophthalmoplegia, ptosis and amaurosis in a cleft patient resulting from infraorbital block following Le Fort 1 osteotomy. This case and review of the literature illustrates the importance of considering and recognising the full range of causes that can give rise to these signs following facial surgery or trauma.

Cardiopulmonary Effects and Pharmacokinetics of Dexmedetomidine Used as an Adjunctive Analgesic to Regional Anesthesia of the Oral Cavity with Levobupivacaine in Dogs.

Simple SummaryThe modern approach to multimodal analgesia is based on the use of various types of analgesics before, during, and after surgery, including local anesthetics, such as levobupivacaine. Dexmedetomidine is used as an adjunctive analgesic to enhance the efficacy and duration of local anesthetics, but its use may be associated with dose-related adverse effects, such as hypertension and bradycardia. The primary aim of the study was to investigate the cardiopulmonary effects of dexmedetomidine administered perineurally as an adjunctive analgesic to regional anesthesia of the upper and lower jaw with levobupivacaine in anesthetized dogs. The secondary aim of the study was to investigate the pharmacokinetics of dexmedetomidine to explain the changes in cardiopulmonary parameters due to dexmedetomidine administration. Infraorbital administration was associated with faster absorption of dexmedetomidine, while application into the submucosa near the inferior alveolar nerve resulted in better bioavailability and faster elimination. Perineural administration of dexmedetomidine was associated with lower plasma concentration compared to intravenous administration and may be preferable because it induces a less pronounced cardiovascular response in terms of hypertension and bradycardia.This study investigated the cardiopulmonary effects and pharmacokinetics of dexmedetomidine (DEX) used as an adjunctive analgesic for regional anesthesia of the oral cavity with levobupivacaine in anesthetized dogs. Forty dogs were randomly assigned to four groups of 10 dogs. All dogs received levobupivacaine (4 blocks) with DEX IO (infraorbital block, n = 10) or IA (inferior alveolar block, n = 10) or placebo (PLC; n = 10) or DEX (n = 10) was injected intravenously (IV) after administration of levobupivacaine. The dose of DEX was always 0.5 µg/kg. Cardiopulmonary parameters were recorded, and blood was drawn for the quantification of DEX in plasma using LC-MS/MS. Heart rate was lower in all LB + DEX groups, while mean arterial pressure (MAP) was higher in the LB + DEX IV and LB + DEX IA groups compared to the LB + PLC IV group. Compared to DEX IV, IO and IA administration resulted in lower MAP up to 2 min after application. Absorption of DEX was faster at IO administration (Cmax and Tmax were 0.47 ± 0.08 ng/mL and 7.22 ± 1.28 min and 0.76 ± 0.09 ng/mL and 7.50 ± 1.63 min for the IO and IA block, respectively). The IA administration resulted in better bioavailability and faster elimination (t1/2 was 63.44 ± 24.15 min and 23.78 ± 3.78 min for the IO and IA block, respectively). Perineural administration of DEX may be preferable because of the less pronounced cardiovascular response compared to IV administration.

A randomized controlled trial of infraorbital block using ketamine 1% for intra- and postoperative analgesia in children for ambulatory cleft lip correction

BACKGROUND In Indonesia, cleft lip correction surgery is often done as a social program in remote areas with limited resources. This study aimed to assess the effectiveness of ketamine, a cheaper and more accessible alternative, as a local analgesia in infraorbital block and to determine the possibility of ketamine as an alternative local analgesic drug for intraoperative and postoperative periods.&#x0D; METHODS This was a randomized controlled trial in children aged 2 months to 5 years who underwent cleft lip correction surgery at Cipto Mangunkusumo Hospital in 2016. Subjects were randomly divided into two groups: ketamine and bupivacaine. Standard general anesthesia with endotracheal intubation was performed in each group. Bilateral intraoral infraorbital block was performed using ketamine 1% 0.5 ml or bupivacaine 0.25% 0.5 ml. Postoperative evaluation includes pain scores based on the face, leg, activity, cry, and consolability (FLACC) scale and analgesic duration.&#x0D; RESULTS A total of 36 subjects were enrolled in this study, with 18 in each group. Both groups received the same total amount of fentanyl addition intraoperatively (p = 1). The postoperative FLACC pain scale scores between the two groups were not different, with p&gt;0.05 in every measurement. The mean duration of postoperative analgesia in the ketamine group was longer than the bupivacaine group (15–13.49 hours, p = 0.031).&#x0D; CONCLUSIONS Infraorbital block with 1% ketamine 0.5 mg/kg was similarly effective for intraoperative and postoperative analgesia but had a longer duration than that with 0.25% bupivacaine 0.5 ml in ambulatory cleft lip correction.

Iatrogenic ocular trauma associated with infraorbital block performed for rhinoscopy in a cat: case report and preliminary imaging findings.

ObjectivesThis paper describes a case of endophthalmitis in a feline patient caused by globe penetration during an infraorbital block performed to provide analgesia during rhinoscopy, and presents additional imaging and dissection data demonstrating risk of iatrogenic ocular trauma during infraorbital blocks in cats when the infraorbital canal is entered.MethodsCase records and accompanying histopathologic reports were reviewed for the feline patient. Separately, two feline cadavers were imaged using CT following placement of 5/8" 25 G needles or 1" 22 G over the needle catheters in the infraorbital canal. Infraorbital blocks with injection of trypan blue dye followed by dissection were performed in two further feline cadavers to assess the potential for globe penetration and to provide preliminary information regarding the potential efficacy of infraorbital blocks for analgesia during rhinoscopy.ResultsClinical and histopathologic findings support inadvertent globe penetration during infraorbital block as the cause for endophthalmitis in the feline patient described. CT imaging and dye injection studies further demonstrate the risks involved with this local anesthetic technique in cats.Conclusions and relevanceFurther study is needed to assess the safety and efficacy of infraorbital blocks performed for rhinoscopy in cats. Catheters may be safer anesthetic delivery devices than needles. Extreme caution should be used when entering the infraorbital canal in cats.

Effect of bilateral infraorbital nerve block on intraoperative anesthetic requirements, hemodynamics, glycemic levels, and extubation in infants undergoing cheiloplasty under general anesthesia.

BackgroundInappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared.MethodsThis prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2–2.5%, followed by fentanyl 0.5 µg/kg bolus. The chi-square test and independent-sample t-test were used where applicable.ResultsDemographics, duration of surgery, and intravenous fluids used were comparable between the groups. Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 µg vs. 22.1 ± 6.2 µg) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium.ConclusionSupplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.

Dexmedetomidine as an adjuvant to infraorbital block in children undergoing cleft lip surgery – A clinical comparative study

Regional nerve blocks provide excellent analgesia in children without adverse effects. However the duration of analgesia may be limited therefore addition of adjuvants can effectively prolong the duration of analgesia. Since alpha 2 agonist effectively prolong the duration of analgesia, we conducted a randomised double blind study to evaluate the effectiveness of dexmedetomidine as an adjuvant in infraorbital nerve block.: Eighty children of ASA grade 1 and 2, of either sex scheduled for cleft lip repair under general anaesthesia were allocated randomly into one of two equal groups (Group B and Group D, n=40). In both group sinfraorbital nerve block was performed with 1ml of solution on each side. The B group received bupivacaine 0.25% and the D group received b upivacaine 0.25% with 0.5µg/kg dexmedetomidine. The mean duration of analgesia and number of patients receiving rescue analgesia was recorded in both groups. The intraoperative hemodynamic parameters and postoperative sedation scores were recorded. For pain and sedation scores, Mann–Whitney U-test was used. Fisher’s exact test was used for comparison of categorical data. P ≤ 0.05 was considered as the level of statistical significance.Both groups were comparable in demographic profile. The mean duration of analgesia in Group D (733±49.15 minutes) was significantly longer compared to Group B (496±28.26) (p=0.001). There was a statistically significant difference in the number of patients receiving rescue analgesics in Group B (36) and Group D(8). The number of times of rescue analgesics in Group B and Group D was 3and 1 respectively, which was statistically significant. The intraoperative and postoperative hemodynamic HR was comparable in both groups (). The sedation score in the postoperative period did not differ between the two groups.

Evaluation of postoperative analgesic effects of infraorbital nerve block by levobupivacaine vs. Ropivacaine after cleft palate surgery: A double-blinded randomized trial

Background: Both ropivacaine and levobupivacaine have been used for the peripheral block in children for surgical pain. The present study is aimed to compare the effectiveness of 0.375% levobupivacaine and 0.375% ropivacaine in the infraorbital block for cleft palate surgery. Patients and Methods: Eighty patients between the age group of 2–12 years planned for elective surgery for cleft palate were included in the study. The solution for Group L was a mixture of 0.375% levobupivacaine and the solution for Group R was a mixture of 0.375% ropivacaine. Infraorbital nerve blocks were conducted by landmark-guided technique. We used the Verbal Rating Scale (VRS) to assess the postoperative pain. Results: There was a statistically significant difference in the time interval until the first request for pain medication was made by the participants in the two groups (10.6 [8.4, 12.8] vs. 8.5 [6.1, 10.8] h, P = 0.002). There were differences in pain scores calculated at regular intervals after surgery comparing the two groups (2.7 ± 0.3 vs. 3.6 ± 0.3, P = 0.01). There were differences in the need for rescue analgesics comparing the two groups. Conclusion: The analgesic effects of levobupivacaine are statistically better than ropivacaine in the infraorbital block in children who underwent cleft palate surgery.

Combined Nasociliary and Infraorbital Nerve Block: An Effective Regional Anesthesia Technique in Managing Nasal Bone Fractures

Background: Closed reduction of the fractured and displaced nasal bones results in nasal bleeding at the site of fracture which needs judicious management. Usually general anesthesia is used with orotracheal intubation, whereas managing these cases with combined nasociliary and infraorbital blocks needs a better understanding of the surface landmark and foraminal anatomy. Materials and methods: We report a randomized study of 2 groups of 25 patients each, with fractures of the nasal bones in our institution over 12 months. Group I included 25 patients with nasal bone fracture reduction done under general anesthesia, and group II included 25 patients in whom regional block anesthesia was given. Most of the patients in the study were in the ASA grade I and II and all had obvious nasal deformity observed and recorded with a history of trauma and injury. Results: The time for full sensory loss in group A was 45 minutes and 21 minutes in group B. The procedure time of 12 minutes was the same in both the groups, while an added imaging time of 15 minutes resulted in an overall procedure time of 27 minutes. Splints were used for septal support as well as externally, which needed an extra 20 minutes for the gypsum salt or the thermoplast to settle. The time of recovery was immediate in group B, while 20 minutes of recovery was seen in group A. Most of the patients in group A commented a painless recovery, while most patients of group B commented an experience of discomfort during the procedure. Conclusion: Unilateral fractures were reduced under regional block anesthesia. Comorbidities should overweigh compliance while preferring regional anesthesia, as the risks involved in general anesthesia have been reduced to the minimum possible extent. The regional block has reduced the operative costs but the complications of the procedure are nearly equal in both types of anesthesia.

Patient Satisfaction with Hyaluronic Acid Fillers for Improvement of the Nasolabial Folds in Type IV &amp; V Skin

Soft tissue augmentation by hyaluronic acid filler injections has become the most commonly done cosmetic procedure in the last 10years. These are now being widely used for improvement of the nasolabial folds. The present study was done to evaluate the patient satisfaction after these injections. The study was conducted on 10 consenting patients. Hyaluronic acid filler (22.5ml cross linked), 1ml on each groove was injected under an infraorbital block. Patient satisfaction was evaluated at 0, 14, 30, and 180days. Photographic record was maintained. Any side effects experienced by the patients were recorded. All the patients were satisfied immediately after the procedure. More than 50% were not happy at 14days. Majority of the patients were happy at 30days and the satisfaction was maintained at 6months. Fillers are a very safe and effective modality for improving the nasolabial fold. This could prove to be a very useful tool in dental practice. Setting the patient expectations before the procedure is performed can lead to satisfied and happy patients.

Penetrating Globe Injury During Infraorbital Nerve Block

Penetrating globe injury is a possible complication after ocular local anesthesia (including peribulbar and retrobulbar blocks). 1-3 Regional nerve blocks of the face are frequently performed by a variety of physicians, including anesthesiologists, otolaryngologists, and other facial surgeons. We describe a case of penetrating globe injury that occurred during an extraoral infraorbital block due to passage of the needle through the infraorbital canal.

A survey of local anaesthesia education in European dental schools

A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students. A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%. Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non-human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra-orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models. Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.

A comparison of bilateral infraorbital nerve block with intravenous fentanyl for analgesia following cleft lip repair in children

The efficacy of analgesia with bilateral infraorbital nerve block and intravenous (i.v.) fentanyl were compared for cleft lip surgery in children. Eighty-two children aged 3 months to 10 years undergoing cleft lip repair were prospectively randomized to one of two groups: bilateral infraorbital nerve block (Group B), or i.v. fentanyl (Group F). Group B (n = 41) received bilateral infraorbital injection of 1 ml 0.25% bupivacaine and 2 ml i.v. saline as control. Group F (n = 41) received 2 microg x kg(-1) i.v. fentanyl, and bilateral infraorbital injection of 1 ml saline as control. Pain was evaluated by the incidence of tachycardia, hypertension, and/or modified pain score > or =4. The time to awakening, time to first cry and time to feeding were noted. Thirty four children (82.9%) in Group B had adequate analgesia compared with 15 (36.6%) in Group F (P < 0.0001, RR of failure 0.27 for Group B). Group B had a mean time to awakening of 5.65 +/- 2.52 min (Group F: 9.37 +/- 4.50 min; P < 0.0001), time to first cry 32.14 +/- 18.22 min (Group F: 28.00 +/- 16.27 min; P = 0.3), time to feed 62.05 +/- 20.06 min (Group F: 72.44 +/- 17.72; P = 0.015), and pain score 2.81 +/- 1.38 (Group F: 4.71 +/- 1.89; P < 0.0001). There were no major complications. Bilateral infraorbital block is superior to fentanyl in terms of analgesia, and time to awakening and feeding.

Regional Anesthesia for Cleft Lip Repair: A Preliminary Study

To assess whether local anesthetic blockade of the infraorbital nerve may allow for cleft lip repair to be performed under regional anesthesia. Twenty patients above 12 years of age with cleft lip (7 females and 13 males) were enrolled. Careful preoperative counseling was given. Bilateral infraorbital block was performed (extraoral approach) with 10 mL of equal volumes of 2% lidocaine with 1:200,000 adrenaline and 0.5% bupivacaine. The point of entry was the intersection of a vertical line through the pupil of the eye (in the neutral position) and a horizontal line through the ala of the nose. The needle was directed medially and cephalad until the infraorbital foramina was reached and 2 mL was injected. Through the same point of entry, but directed medially (toward the ala), 1 mL was injected followed by a 2-mL injection caudally and medially (into the lip). The block was successful in all patients without complication. The surgery was uneventful, lasting between 45 and 60 minutes. The postoperative duration of analgesia was between 6 and 24 hours (mean 16.5 +/- 5.10 SD). The nerve supply of the cleft lip, our modification of the block, and possible problems with this technique are discussed. This study confirms the utility of this block for postoperative analgesia. Further studies are required to apply this innovative, safe, and economical modification of anesthesia for cleft lip surgery.

Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

ABSTRACTIn this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline.The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively.We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

Regional anaesthesia for outpatient nasal surgery

Regional anaesthesia is not used widely for outpatient nasal surgery. The aim of this study was to determine the role of nasociliary and infraorbital nerve block in 24 patients undergoing nasal surgery comprising: cosmetic or reconstructive surgery of the nose and surrounding soft tissue, polypal removal, turbinectomy, reduction of fractured nasal bones, small tumour resection or emergency surgery on isolated facial lacerations. Mild sedation with midazolam 0.03 mg kg-1 was used before anaesthesia. Nasociliary and infraorbital blocks were technically easy to perform, safe and provided good intraoperative conditions. Only minor complications were observed, including local bruising in eight patients and transient diplopia in one patient. No patient received general anaesthesia, but infiltration of local anaesthetic was necessary in four patients because of incomplete anaesthesia in the surgical area. Operative conditions were judged as good or excellent by surgeons in 20 of 24 patients. Twenty of 24 patients were very satisfied or satisfied with anaesthesia. Duration of surgery exceeding 60 min and excessive bleeding in the nasopharynx were the main limiting factors for the use of facial regional anaesthesia.

Bilateral Infraorbital Block with 0.5% Bupivacaine as Post-Operative Analgesia Following Cheiloplasty in Children

Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. In every patient, the surgeon infiltrated the lip with 4-7 ml of 1% lidocaine with 1:100,000 epinephrine for both anesthesia and hemostasis. Post-operative evaluations were completed after 4, 8, and 12 to 24 hours and were based on a visual analogue scale for pain. Similarly, the nurses and the parents also evaluated post-operative discomfort using specific criteria. All the observers were kept unaware of the solutions used for the block. The results showed that Group A was pain free for a mean duration of 19.4 +/- 5.06 (SD) hours in contrast to 11.7 +/- 6.19 hours for Group B, (p less than 0.001). Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)