Infraorbital Nerve Block Research Articles

Comparação da Eficácia Anestésica da Articaína 4% Associada a Epinefrina 1:100.000 e 1:200.000 na Técnica Infraorbitária

Objective: To compare the anesthetic efficacy of 4% articaine associated with epinephrine concentrations of 1:100,000 and 1:200,000, using the infraorbital nerve block approach. Material and Methods: This is a double-blind cross-sectional study conducted with 40 volunteers. Pulpal anesthetic parameters such as latency, duration, and success rates were evaluated using a pulp tester device, which emits electrical discharges ranging from 0 to 80 ?A in 20 seconds. Soft tissue anesthesia (vestibular gum) was evaluated by pressing a wooden toothpick into the gingival region used in the approach. Finally, parameters related to pain after anesthesia were evaluated. Results: We found no statistically significant differences between anesthetic solutions for pulp and soft tissue regarding latency period. The anesthetic solution containing 1:100,000 epinephrine presented a significantly longer effect duration than 1:200,000 epinephrine regarding pulpal anesthesia of maxillary central incisors, first maxillary premolar, and second maxillary premolar. As for vestibular gum, we found no statistically significant differences between the solutions. Regarding pain at injection, the two anesthetic solutions showed no statistically significant differences. Conclusion: 4% articaine with 1:100,000 epinephrine presented significantly longer pulpal anesthesia duration in some dental elements when compared to 1:200,000 epinephrine

Infra-orbital nerve block using alar base approach: A novel landmark and technique

The infra-orbital nerve block is given to anaesthetize the anterior part of maxilla by depositing the local anesthetic agent in proximity of the infra-orbital nerve foramen. The two intra-oral approaches well documented in the literature are the ‘central incisor approach’ or the ‘bicuspid approach’. In 2011, Infra-orbital nerve block with extended coverage using the intra-oral ‘molar approach’ was employed. However, infra-orbital nerve block can pose a challenge in patients with no teeth. We have devised a novel landmark and technique for infra-orbital nerve block using the anatomical landmark alar base.

Peri-Operative Pain Management for Cleft Lip Repair in Children, Bilateral Infraorbital Nerve Block Versus Combined Intravenous Fentanyl with Peri-Incisional Infiltration. A Randomized Comparative Study

Background: The good control of postoperative pain has an important impact on the patient as regards his general condition, wound healing and hospital stay. Regional nerve blocks and systemic analgesics especially opioids offered this control but with superiority of the regional block due to avoidance of the side effects of opioids. The assessment of pain in pediatrics is difficult, as they usually do not have the ability to describe their pain. Pediatric patients undergoing cleft lip repair can benefit from nerve blocks related to the lip. Different types of analgesia were described, such as bilateral infraorbital nerve block (IONB), pharmacological analgesics and surgical site infiltration. Objective: To compare the effect of bilateral infraorbital nerve block with conventional methods (IV fentanyl and peri-incisional infiltration) as a proper perioperative pain management in children undergoing cleft lip (CL) repair operation. Patients and Method: Seventy-six children, scheduled for cleft lip repair, were enrolled in this study in Cairo University Pediatric Hospital (Abu El Reesh). The patients were randomly assigned into two groups: Group infraorbital nerve block IONB (n=38): received bilateral infraorbital nerve block. Group conventional (n= 38): received IV fentanyl with surgical site infiltration. Patients in both groups received general anesthesia and our interventions were performed after induction of anesthesia and before skin incision. Results: This study demonstrated that the use of bilateral IONB in children undergoing cleft lip repair was accompanied by superior levels of intraoperative and postoperative analgesia as compared to the use of IV fentanyl with surgical site infiltration in the same population. This difference was evidenced by significantly less need for postoperative rescue analgesia as well as lower pain scores up to 24 hours postoperative in the IONB group. Conclusion: This study results indicate that bilateral ION block is simple, safe and technically easy to perform with good postoperative analgesia.

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.

Effects of Adding a Combined Infraorbital and Infratrochlear Nerve Block to General Anaesthesia in Septorhinoplasty.

PurposeIn this study, we evaluated the hypothesis that preoperative bilateral infraoptic nerve (ION) and infratrochlear nerve (ITN) blocks under general anesthesia with sevoflurane and remifentanil reduced the incidence of emergence agitation (EA), pain scores, and the analgesic consumption after the septorhinoplasty.Patients and MethodsOur study was conducted as a prospective randomized, double-sided blind study. Fifty-two patients whose septorhinoplasty operation was planned under general anesthesia were included in the study. Patients were randomly distributed to either the ION and ITN blocks were performed. Group 1: Bilateral ION and ITN blocks were performed; Group 2: ION and ITN blocks were not performed. Duration of the surgery and anesthesia, Riker Sedation-Agitation Scale (RSAS) score, EA presence, duration of postoperative analgesia, numerical rating scale (NRS) scores, and cumulative dexketoprofen consumption were recorded.ResultsThe RSAS score, NRS score and cumulative dexketoprofen consumption of the patients in Group 1 were statistically significantly lower than the patients in Group 2 (p<0.05). It was also found that patients in Group 1 (n: 8/26) had less EA compared to patients in Group 2 (n: 16/26) and this difference was statistically significant (p: 0.026). Postoperative analgesia duration of patients in Group 1 was found to be statistically significantly higher than patients in Group 2 (p: <0.001). In addition, the number of patients given postoperative dexketoprofen in Group 1 (n: 8/26) was found to be statistically significantly lower than patients in Group 2 (n: 25/26). (p: <0.001).ConclusionBilateral ION and ITN blocks in septorhinoplasty operation is an effective, reliable and simple technique in the treatment of postoperative pain.

Comparison of the efficacy and duration of desensitization of oral structures following injection of various volumes of a lidocaine-bupivacaine mixture via an infraorbital approach in dogs.

To compare the efficacy and duration of desensitization of oral structures following injection of various volumes of lidocaine-bupivacaine via an infraorbital approach in dogs. 6 healthy adult hound-type dogs. In a randomized crossover study, each dog received 1, 2, and 3 mL of a 2% lidocaine-0.5% bupivacaine mixture (50:50 vol/vol) injected within and near the caudal aspect of the infraorbital canal with a 14-day washout period between treatments. Dogs were anesthetized, and each treatment was administered through a 22-gauge, 4.5-cm-long catheter, which was fully inserted through and then withdrawn 2 cm to the caudal aspect of the infraorbital canal. The reflex-evoked motor potential was measured for the maxillary canine tooth (MC), fourth premolar tooth (MPM4), second molar tooth (MM2), and hard palate mucosa ipsilateral to the injected treatment and for the contralateral MC (control) at predetermined times before and for 6 hours after treatment administration or until the block was no longer effective. For each oral structure, the proportion of dogs with desensitization (efficacy) and time to onset and duration of desensitization were compared among the 3 treatments (injectate volumes). Treatment was not associated with efficacy, time to onset, or duration of desensitization. Regardless of treatment, MC and MPM4 were more frequently desensitized and mean durations of desensitization for MC and MPM4 were longer, compared with those for MM2 and the hard palate. The volume of local anesthetic used for an infraorbital nerve block had no effect on block efficacy or duration.

Nerve Block for Septorhinoplasty: A Retrospective Observational Study of Postoperative Complications in 24 Hours.

Septorhinoplasty is a surgical procedure that provides functional improvements and esthetic adjustments to the appearance of the nose. Pain is a common postoperative complication, and pain management is known to decrease postoperative complications and total cost. Local anesthetics can cost-effectively decrease postoperative pain scores and reduce analgesic requirements.The primary objective of this study was to assess the effect of bilateral facial nerve blocks given with general anesthesia on pain scores and the use of postoperative analgesia. The secondary objective was to compare the vital signs stability between a group given bilateral facial nerve blocks with general anesthesia and a group given general anesthesia only.We conducted a retrospective observational study among 40 patients who were divided into two groups, each containing 20 patients. The patients in the nerve block (NB) group received general anesthesia and bilateral facial blocks of the infraorbital and infratrochlear nerves via 5 ml of 0.25% levobupivacaine with 5 ml of diluted adrenaline 1:100,000. Patients in the Control group received general anesthesia only. Both groups received the same local injection of a mixture of 5 ml of 1% lidocaine and 5 ml of 1:100,000 epinephrine at the surgical site, along with the standard general anesthesia. A numerical rating scale, the visual analog scale (VAS), was used to evaluate postoperative pain at 15, 30, and 45 minutes postoperatively, and the stability of the vital signs was also assessed.The results showed that using bilateral infraorbital and infratrochlear nerve block injection with 0.25% levobupivacaine for patients who underwent septorhinoplasty under general anesthesia provided greater stability of vital signs but had no effect on the pain score or analgesia need. Further assessment should be performed in a larger number of patients to either confirm or refute these results. Additional studies could be conducted in several hospitals within the Kingdom to determine how broadly applicable nerve blockade is in reducing pain sensation.

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery.

An infraorbital nerve (ION) block is widely used to accomplish regional anesthesia during surgical procedures involving the midface region. This study aimed to elucidate the exact location of the infraorbital foramen (IOF) in relation to clinically useful soft-tissue landmarks for achieving an effective ION block. Forty-three hemifaces from 23 embalmed Korean cadavers were dissected. The lateral canthus, peak of Cupid's bow, medial limbus, and midline were used as reference points. The distances from the IOF to the midline and the lateral canthus were measured. The IOF was located approximately 25 mm below the lateral canthus and 27 mm lateral to the midline. In all cases, the IOF was situated within 9.0 mm of the crossing point of the oblique line connecting the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus. Considering the spread of an anesthetic agent, injecting it into the crossing point of the oblique line through the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus would successfully block the ION in most patients.

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.

Comparison of Pain Levels between Infraorbital Nerve Block with and without Greater Palatine Anaesthesia during Orthodontic Extraction: A Split-Mouth, Prospective Study

Comparison of Pain Levels between Infraorbital Nerve Block with and without Greater Palatine Anaesthesia during Orthodontic Extraction: A Split-Mouth, Prospective Study

Effectiveness of the Greater Palatine Nerve Block for Anaesthetising Anterior Palate: A Prospective Study

Introduction: Local Anaesthesia (LA) is the mainstay of any routine dental extraction. Accomplishing optimum anaesthesia with least pain and anxiety to patients is a challenge. Hence, modification of technique and application of routine dental LA to enhance patient comfort is the need of the hour. In this pursuit, a prospective cohort study was carried out to evaluate the effectiveness of greater palatine nerve block as an alternative to nasopalatine nerve block in anaesthetising the anterior palatal mucosa and to achieve optimum palatal anaesthesia. Aim: The primary outcome variable is to assess the extent of the anaesthetic effect of greater palatine nerve block in maxillary anterior palatal region. Materials and Methods: A total of 100 patients scheduled for the extraction of ipsilateral anterior and posterior maxillary teeth were included in this prospective study between June 2017 to June 2019. Palatal anaesthesia for all the extractions done was achieved only with greater palatine nerve block. After an interval of five minutes, the extent of palatal anaesthesia from the posterior palatal tissue to the anterior region was evaluated for both subjective and objective symptoms. Pain on the palatal mucosa was assessed using Numerical rating scale of 0-10. Post-evaluation, depending on the proposed tooth of extraction, buccal anaesthesia was achieved with Posterior superior alveolar nerve block for posterior teeth and infraorbital nerve block for anterior teeth. Results: Of the 100 patients administered with greater palatine nerve block, it was observed that in 36 patients (36%) had effectiveness in anaesthesia till central incisor, 28 (28%) patients had effectiveness in anaesthesia till lateral incisor, 20 (20%) patients had effective in anaesthesia till the canine and 16 (16%) patients anaesthetic effects were limited to posterior teeth. Overall, 84% had varied degree of positive anterior anaesthesia with greater palatine nerve block alone. Conclusion: Greater palatine nerve block was effective in providing anaesthesia to the posterior region till the premolars, with the extended complete anaesthesia in the anterior region with similar action as the nasopalatine nerve block administered to anaesthetise the anterior palate for extraction of the anterior teeth.

Postoperative Analgesic Effects of Infraorbital Nerve Block in Cleft Palate Surgery

Postoperative Analgesic Effects of Infraorbital Nerve Block in Cleft Palate Surgery

&lt;p&gt;Introduction of pulsed radiofrequency cautery in infraorbital nerve block method for postoperative pain management of trauma-induced zygomaticomaxillary complex fracture reduction&lt;/p&gt;

Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies.

Effects of Bilateral Infraorbital and Infratrochlear Nerve Block on Emergence Agitation after Septorhinoplasty: A Randomized Controlled Trial.

Emergence agitation is common after septorhinoplasty, and postoperative pain is the main risk factor for this condition. Infraorbital and infratrochlear nerve block have been reported to facilitate pain management in patients after nasal procedures. The effect of peripheral nerve block on the incidence of emergence agitation has not been evaluated. Sixty-six patients that were scheduled for septorhinoplasty were assigned to receive bilateral infraorbital and infratrochlear nerve block with either 8 mL of 0.5% ropivacaine (Block group) or isotonic saline (Sham Block group). The incidence of emergence agitation was evaluated using the Riker sedation-agitation scale. Analgesic consumption, hemodynamic parameters, postoperative pain scores, adverse events, and patient satisfaction with analgesia were evaluated. The incidence of emergence agitation was lower in the Block group than in the Sham Block group (6 (20.0%) versus 20 (62.5%), p = 0.002). The mean intraoperative remifentanil consumption was lower in the Block group than in the Sham Block group (0.074 ± 0.014 μg/kg/min. versus 0.093 ± 0.019 μg/kg/min., respectively, p < 0.0001), as was the proportion of patients that needed postoperative tramadol administration and median postoperative pain score at 0–2 h after surgery (9 (30.0%) versus 21 (65.6%), p = 0.011; 3.0 (2.0–4.0) versus 4.0 (3.0–4.0), p < 0.0001, respectively). Hemodynamic parameters and the incidence of adverse events were similar between the two groups. The median patient satisfaction score with respect to analgesia was higher in the Block group than in the Sham Block group (3.5 (3.0–4.0) versus 3.0 (3.0–4.0), respectively, p = 0.034). The preoperative bilateral infraorbital and infratrochlear nerve block decreased the incidence of emergence agitation after septorhinoplasty.

Ex vivo evaluation of the distribution of a mixture of mepivacaine 2% and iopromide following local infiltration of the infraorbital nerve via the infraorbital foramen

SummaryThe objective of this study was to investigate the distribution pattern of two different volumes of a mepivacaine 2%/iopromide mixture along the infraorbital nerve using a controlled injection pressure. Infraorbital nerve blocks were performed at the infraorbital foramen with two different volumes (group 10: 10 mL or group 15: 15 mL) using a 22 gauge, 3 cm long needle and a standardised injection pressure in 10 cadaver skulls. Ten minutes after injection, computed tomography was performed in all skulls. Images were analysed for needle position, length of the iopromide column, filling percentage of the infraorbital canal, presence of iopromide at the maxillary foramen, volume of leakage, length and angle of the infraorbital canal and pathological changes. Percentage of infraorbital canal filling ranged from 74% ± 0.23 to 86.9% ± 0.24 and iopromide was present at the maxillary foramen in 70–90% of the blocks of groups 15 and 10 respectively; neither variables differed significantly between groups 15 and 10 (P = 0.582 and P = 0.244 respectively). Mean leakage retrograde into the rostrally surrounding tissue and into the maxillary sinus was significantly greater in group 15 (7.9 cm3 ± 4.2) than group 10 (3.02 cm3 ± 3.13), P = 0.008. Older horses were significantly associated with higher filling percentages (P = 0.049), whereas filling percentages or whether the mixture reached the maxillary foramen were not associated with any of the other variables. Infraorbital nerve blocks using 10 and 15 mL result in complete filling of the infraorbital canal in the majority of horses. This block may result in sufficient analgesia of Triadans 06 to 11 and offer a suitable safe alternative to maxillary nerve blocks.

The Infraorbital Foramen Location in the Perinatal Maxilla: Implications for Infraorbital Nerve Block

Bilateral infraorbital nerve block is performed in infants for the management of pain after cleft‐lip repair. The procedure involves the injection of anesthetic near the emergence of the infraorbital nerves in the face at the infraorbital foramen. In adults, infraorbital foramen location is oftentimes estimated via measurements from the lateral nasal aperture and the infraorbital margin; however, these measurements have not been described in the perinatal population. Therefore, this study assesses the distances from the lateral nasal aperture and the infraorbital margin to the infraorbital foramen in 66 fetal and infantile maxillae ranging from 5 months intrauterine development to 15 months postnatal development. The best‐fit linear model for IOF location is with regard to the distance from the lateral nasal aperture to the IOF. The model is given by the formula Distance = 0.1747 × Age (in developmental months) + 4.4433 and has an r2 value of 0.6145. Linear modeling with respect to the distance from the infraorbital margin to the IOF however was poor with regard to goodness‐of‐fit (r2 = 0.1636). The distance from the infraorbital foramen at 5 months intrauterine age was 2.9mm while, at one year post‐natal was 3.4mm (difference = 0.5mm) and therefore represents little change in maxillary growth in that dimension. On the other hand distance from the lateral aperture at 5 months development was 5.3 mm and at one year was 7.6mm (difference = 2.3mm). The results of this study suggest that the IOF location can be approximated, particularly with regard to the distance from the lateral aperture as a function of age. The results of the study will help to optimize infraorbital nerve block in young patients recovering from cleft‐lip surgery.Support or Funding InformationWV Research Challenge Fund [HEPC.dsr.17.06]This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Comparative evaluation of dexamethasone and dexmedetomidine as adjuvants for bupivacaine in ultrasound-Guided infraorbital nerve block for cleft lip repair: A prospective, randomized, Double-Blind study

Purpose:To compare dexamethasone (DA) to dexmedetomidine (DE) as adjuvants for bupivacaine during infraorbital nerve block (IONB) in a randomized clinical trial.Patients and Methods:One hundred patients were randomized into two equal groups. By the guidance of ultrasound, the IONB was performed bilaterally in all patients, using 1 mL of the solution on each side. In DA group, 1 mL of 0.5% bupivacaine was added to 0.1 mg.kg−1 DA and diluted to 2 mL in DE group; 1 mL of 0.5% bupivacaine was added to 0.5 μg.kg−1 DE and diluted to 2 mL. The primary outcome was time to first rescue analgesic. The secondary outcomes included face legs activity cry consolability (FLACC) score rating during the first 24 h, hemodynamic variables, the incidence of postoperative vomiting, sedation score, and parent satisfaction.Results:During the first 24 h postoperatively, the DE group showed a significantly lower FLACC score and a longer time to first analgesic request compared to DA group. Sedation and parent satisfaction scores were significantly higher while heart rate and mean blood pressure were significantly lower in DE group compared to DA group. There were no differences in other secondary outcomes.Conclusion:The use of DE as an adjuvant to bupivacaine in IONB for cleft lip repair resulted in lower pain score and more prolonged duration of analgesia compared to DA.

Effect of infraorbital nerve block on postoperative pain and 30-day morbidity at the donor site in buccal mucosal graft urethroplasty.

Background and Aims:Buccal mucosa harvest for substitution urethroplasty can be painful, and may be associated with long-term complications such as perioral numbness, persistent difficulty with mouth opening, and change in salivary function. This study was designed to evaluate the efficacy of infraorbital nerve block (IOB) in relieving postoperative pain at the donor site of the buccal mucosal graft (BMG) and its associated morbidity at 30 days.Material and Methods:Thirty adults scheduled for BMG urethroplasty were enrolled in this study and were randomized to receive either no block group I (control) and IOB group II intraorally with 1 mL of 0.5% bupivacaine. Pain was assessed by visual analog scale, intraoral morbidity, and patient satisfaction in the immediate postoperative period. All patients were reviewed after 1 month for morbidity such as perioral numbness, pain on mastication, and tightness on mouth opening. Statistical analysis was done using Mann–Whitney's U and Chi-square tests.Results:Median time to pain-free oral intake for liquids (group I: 2–5 days, group II: 1 day, P < 0.001) and solids (group I: 4 days, group II: 2 days, P < 0.001) was earlier in group II. At the follow-up after 1 month, one patient in group II and three patients in group I showed perioral numbness (P = 0.026), and five patients had pain on mastication in group I (P = 0.016).Conclusion:IOB is associated with postoperative analgesia and facilitation of early food intake, mitigating the morbidity of the donor site and provides satisfaction.

Utility of real-time ultrasound-guided infraorbital nerve block in trigeminal neuralgia

Trigeminal neuralgia (TN) is one of the most painful conditions occurring in the face. It causes sudden, severe, unilateral, sharp, stabbing, or burning pain along the distribution of the trigeminal nerve. Antiepileptic and analgesic medications are the primary choices of therapy. Peripheral trigeminal nerve block is a beneficial treatment option during the acute paroxysmal period of TN in patients who have contraindications or are refractory to pharmacological management. TN at V2 (maxillary) area is reported to account for 37.8% of all TN cases, and 80% of TN at V2 can be treated with infraorbital nerve block. Ultrasound imaging is helpful in localizing the infraorbital foramina for giving superficial trigeminal nerve block. In this case series, we performed real-time ultrasound-guided infraorbital nerve block which is a branch of the maxillary division of the trigeminal nerve. All patients had satisfactory pain relief.

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.