Infraorbital Nerve Block Research Articles

An in vivo study comparing efficacy of 0.25% and 0.5% bupivacaine in infraorbital nerve block for postoperative analgesia.

BackgroundPain is an unpleasant sensation ranging from mild localized discomfort to agony and is one of the most commonly experienced symptoms in oral surgery. Usually, local anesthetic agents and analgesics are used for pain control in oral surgical procedures. Local anesthetic agents including lignocaine and bupivacaine are routinely used in varying concentrations. The present study was designed to evaluate and compare the efficacy of 0.25% and 0.5% bupivacaine for postoperative analgesia in infraorbital nerve block.MethodsForty-one patients undergoing bilateral maxillary orthodontic extraction received 0.5% bupivacaine (n = 41) on one side and 0.25% bupivacaine (n = 41) on the other side at an interval of 7 d. The parameters evaluated for both the bupivacaine concentrations were onset of action, pain during procedure (visual analog scale score [VAS]), and duration of action. The results were noted, tabulated, and analyzed using the Wilcoxon signed rank test.ResultsThe onset of action of 0.5% bupivacaine was quicker than that of 0.25% bupivacaine, but the difference was not statistically significant (P = 0.306). No significant difference was found between the solutions for VAS scores (P = 0.221) scores and duration of action (P = 0.662).ConclusionThere was no significant difference between 0.25% bupivacaine and 0.5% bupivacaine in terms of onset of action, pain during procedure, and duration of action. The use of 0.25% bupivacaine is recommended.

Death by a Thousand Cutting Remarks.

Death by a Thousand Cutting Remarks Hillary Newsome In medical school we learn that the approximate blood volume of a human being is somewhere around 5L. If in order to be in danger of bleeding to death, a person needs to lose over half their blood volume, then I am approaching the path of no return. I’m tachycardic and pale. My mentation has slowed and I’m drifting in and out of consciousness. If someone doesn’t intervene soon, I’ll be gone. Figuratively, anyway. I haven’t suffered a horrible accident. There has been no procedure gone wrong with significant injury to an aberrant artery. Instead, this has been a slow transition. A drop escapes here and there as a papercut I didn’t even know I had. A small stream of red trickles from my finger and gets wiped away. The only evidence of the cut I have is the stinging from the Purell I use in and out of every patient’s room on morning rounds. A random nick shouldn’t be too surprising. After all, I deal with sharps by nature of the job: a 15 blade for a skin incision, an 11-blade for a neck abscess, 30-g for an infraorbital nerve block. I am navigating a surgical world. My attendings, the majority of them white males, have hands that are thick and calloused from their own versions of needle sticks and paper cuts. After all, we see the same patients, do the same procedures, though I perform them much less adeptly at this earlier stage (which may [End Page E10] be a contributing reason for my lower hematocrit). I seem to suffer from a different barrage of miniscule trauma leaching my precious red blood cells. Is it because I am a woman? Or is it because I am black? Because I am a black woman? I’m bleeding, and it’s because I’ve been noticed. “Do you have a self-confidence problem? Because you write like someone who does.” That was the observation made after reviewing my life story on a piece of paper. That was how the interview at my state medical school opened. What had I written in my personal statement that had tipped this middle-aged white man off? A story about a young and black woman traversing the unfamiliar terrain of academia as the first person in her whole entire family pursuing a doctorate degree, despite having been told she should consider a different career? Or was it just because I was a 21-year-old and black woman, which then, and now, is enough to make one second-guess herself. My hemoglobin dropped 1 unit. Needless to say, I did not matriculate into medical school there. “Cystic duct?” I knew that was the answer I read in my textbook while preparing for my general surgery rotation. But the way I said it came off more as a question than an answer. Uptalk. “Don’t talk like that.” She demands. My facial expression turns to puzzled. “Like that? You know?” Her sentence ending with an inflection that mimicked mine. “Women surgeons should not speak like that,” she concluded. Blood splatters on the floor and our eyes dart at the crimson fluid. We both know it’s mine, probably 150cc or so escaping from the stab wound she had created while reminding me there is no room for a young, millennial woman like me in surgery. A surgeon must become intimately aware of her patient’s body. This patient may have a left level three node, which you must be sure to include in the neck dissection, while the next patient may have some anatomic variant you’ve never seen. Unfortunately, something about the way I look—the apparent youth of my dimpled cheeks, the hooding of my eyes, or the texture of my hair— gives each patient just enough courage to forego the social niceties taught to them by their mothers. My patients have seen my full lips, my freckles, my tawny skin, my height and have become so familiar with me in a single meeting that they must tell me their observations of my body...

Ultrasound-guided infraorbital nerve block for cleft lip repair in pediatrics: a new technique for an old block

BackgroundOne of the challenges that anesthesiologist faces is the intra- and postoperative analgesia in cases of cleft lip repair in pediatrics. However, the use of ultrasound infraorbital nerve (ION) block has not been evaluated before in pediatric. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of ultrasound-guided ION block in infants undergoing unilateral cleft lip repair.MethodsSixty infants (ASA status I, II) aged 3–10 months undergoing unilateral cleft lip repair were allocated randomly to two groups (n = 30 each). The bupivacaine group (group B) received ION block with 1 ml 0.25% bupivacaine, and the saline group (group S) received 0.9% normal saline 1 ml in each side by the use of ultrasound. Intraoperative measurements included heart rate and mean arterial blood pressure. Postoperative pain score was recorded at 15 and 30 min, then at 2, 6, 10, and 16 h. If the score exceeded 3 points, 25 mg/kg of paracetamol suppository was given, with recording the time of first rescue analgesia and total dose given in each group.ResultsPostoperative pain, using FLACC (Face, Legs, Activity, Cry, Consolability) score the median scores were higher in the saline group than bupivacaine group at 15 min, 30 min, 2 h, 6 h and 10 h. There was significantly longer time in the bupivacaine group than the saline group for first rescue analgesia (476.6 ± 100.7 vs 21 ± 6 min respectively, P ˂ 0.001). Whereas more number of paracetamol doses were required in the saline group when compared to bupivacaine group, total dose of paracetamol was significantly lower in the B group than the S group.ConclusionsUltrasound-guided bilateral ION block provides a superior postoperative analgesia for infants undergoing cleft lip repair. It is a simple and easy to perform technique, with high success rate and minimal complications.

Quantitative and qualitative assessment of sensory changes induced by local anesthetics block of two different trigeminal nerve branches.

The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants. This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10min, and 2h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar's tests. There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10min and 2h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10min to most of the QST parameters (P < 0.011). QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2h with significant numbness and perceptual distortion. Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

Pain Reduction in Extensive Apical Surgery of the Anterior Maxilla: A Comparative Clinical Study

The purpose of this study was to compare the outcomes of 2 different anesthetic techniques (local infiltration vs infraorbital nerve block) for eliminating pain during apical surgeries that are associated with extensive periapical pathology in the anterior maxilla. Patients were randomly divided into 2 groups: patients in group I were anesthetized labially by local infiltration injections, whereas those in group II received a single infraorbital nerve block. Palatal injections were given for the 2 groups. Once the pain was initiated during surgery, the procedure was discontinued until profound anesthesia was secured. The studied variables were age, gender, onset of anesthesia, operative time, and intraoperative pain. Any complication associated with the injection techniques, intraoperatively and postoperatively, also was assessed and recorded. Then, the collected data were analyzed using proper statistical methods. The significance level was set at a P value less than or equal to .05. One hundred patients (50 per group; age range, 16 to 43yr), predominantly men, were enrolled in this study. The results showed rapid onset of anesthesia in group II with a highly significant difference from group I (P≤.05). Duration of the operation ranged from 44 to 57minutes. Pain during the surgical procedure was reported by most patients in group I (92%). Collateral anesthesia (82%) and increased numbness of the upper lip (72%) were reported in group I. Ecchymosis at the infraorbital foramen or rim (8%) and paresthesia in the skin over the infraorbital region (6%) and cheek (4%) were observed in group II. In apical surgeries, the anesthetic efficiency of the infraorbital nerve block was superior to that of local infiltration. It had rapid onset, longer duration, and greater potency and avoided multiple transmucosal injections. Furthermore, it was associated with minor and transient side effects.

Morphometric analysis of infraorbital foramen in South Indian dry skulls

Objective- The infraorbital foramen is located on the maxillary bone 1 cm under the infraorbital margin. Infra orbital nerve blocks are done in children for managing the postoperative pain which can occur after cleft lip operation and endoscopic sinus operation. Infraorbital nerve can also be damaged in cases of zygomatic complex fractures which are one of the most common facial injuries. So, this study was undertaken to analyze the anatomical variations by comparing various morphometric measurements of infraorbital foramen in dry skulls of adult South Indian population.Materials and methods- 60 dry skulls of unknown sex were used for the study. Various measurements and distance from various surgical landmarks were measured to evaluate the location of infraorbital foramen on both sides. Statistical Analysis was done for the above measurements mean and standard deviation, median, range, and mode were calculated.Results: The mean distance of infraorbital foramen from piriform aperture, lower end of alveolus of maxilla and infraorbital margin was 18.39, 27.88 and 7.09mm on the right and 17.89, 27.31 and 6.95mm on the left side. The mean vertical and horizontal diameter was 3.78 and 3.50mm on the right side and 3.48 and 3.35mm on the left side. In our study, the most common site of IOF in Indian skulls was found to be in line with the second premolar tooth (59.01%), followed by its position between the first and second premolar tooth (27.87%).Conclusion- These results will be helpful for surgeons while doing maxillofacial surgery and regional block anesthesia.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.562-566

Infraorbital foramen location in the pediatric population: A guide for infraorbital nerve block.

Infraorbital nerve blocks are often performed for the management of postoperative pain associated with cleft lip correction. Infraorbital nerve block procedures depend on the identification of the infraorbital foramen; however, there is little information regarding the infraorbital foramen location in the pediatric population. The aim of this study was to identify the location of the infraorbital foramen in the pediatric population relative to a midpoint between the nasospinale and jugale. The study assessed the location of 152 infraorbital foramina relative to a midpoint between the nasospinale and J on dry crania. Crania were from individuals ranging in age-at-death from 6-month fetal to 18years. The population was subdivided into fetal/infant (≥6months fetal age-<2years), child (≥2-<12years), and adolescent (≥12-≤18years) groups for comparison. The average distance of the infraorbital foramen from the nasospinale-to-jugale midpoint was 1.55±0.78mm (Mean±SD) in the fetal/infant group, 0.80±0.91mm in the child group, and 1.31±1.68mm in the adolescent group. Furthermore, infraorbital foramina tended to be located medial to the nasospinale-to-jugale midpoint in the fetal/infant population, directly upon or superomedial to the nasospinale-to-jugale midpoint in the child population, and directly upon or superior/superolateral to the nasospinale-to-jugale midpoint in the adolescent population. The infraorbital foramen was located within 2mm, on average, from the nasospinale-to-jugale midpoint regardless of age group. Therefore, the nasospinale-to-jugale midpoint may serve as useful means of identifying the location of the infraorbital foramen in the pediatric population and aid in optimizing infraorbital nerve block procedures. The information in this report is valuable in general, but may be particularly useful in developing countries where there is a lack of ultrasound training and availability for health care providers; or places where infraorbital nerve block may be the sole anesthetic modality for cleft lip surgery, even among adolescent patients.

Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair

We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Sixty patients were randomly allocated into two groups (n=30), Group B received infra-orbital nerve block with 2mL of 0.25% Bupivacaine and Group BK received 0.5mg.kg-1 Ketamine for each side added to 1mL of 0.5% Bupivacaine solution diluted up to 2mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p<0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p<0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67±45.67 vs. 240.0±0.0mg, p<0.04). The time to first oral intake was significantly reduced in Group BK (87.67±15.41 vs. 27.33±8.68min, p<0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45min (0.86±0.11 vs. 0.46±0.16, p<0.04) and in the first hour (h) postoperatively (1.40±0.17 vs. 0.67±0.14, p<0.003). Higher parent satisfaction scores were recorded in Group BK (p<0.04) without significant adverse effects. The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

The prevalence of the accessory infraorbital foramen among sexes: preliminary results.

BRANIGAN L. MCGOWAN, DALTON S. BOLON, Dept of Natural Sciences &amp; Mathematics, West Liberty University, West Liberty, WV, 26074, and MATTHEW J ZDILLA, Depts of Natural Sciences &amp; Mathematics and Graduate Health Sciences, West Liberty University, West Liberty, WV, 26074 and Dept of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, WV, 26506. The prevalence of the accessory infraorbital foramen among sexes: preliminary results.The infraorbital foramen is an opening in the maxillary bone below the infraorbital margin of the orbit through which the maxillary nerve travels. The infraorbital foramen is particularly important in nerve block procedures. Occasionally, an accessory infraorbital foramen may be present, complicating nerve block procedures. Therefore, this study assessed the prevalence of the accessory infraorbital foramen among sexes. A total of 565 crania of known sex were assessed (301 males and 264 females). In the total population, 108 of 565 crania (19.1%) were found to have an accessory IOF. With regard to sex, 66 of 301 males (21.9%) and 42 of 264 females (15.9%) were found to have an accessory IOF. The results of this study underscore the importance of screening for the accessory infraorbital foramen in both males and females prior to infraorbital nerve block.

Three‐Dimensional Infraorbital Foramen Location Relative to Facial Landmarks: Preliminary Results

Infraorbital nerve block injections are performed by either an intraoral approach per the oral vestibule or an extraoral approach through the skin near the infraorbital foramen. Many studies have assessed the location of the IOF relative to bony landmarks, teeth, as well as soft tissue landmarks with mixed results. Few studies have assessed the location of the IOF in three dimensions. This study analyzed the location of the IOF relative to a midpoint between the inferolateral nasal aperture and inferolateral orbital rim via three‐dimensional models rendered from 18 adult crania. The distance from the midpoint to the IOF averaged 4.16±1.43 mm (mean±SD) on the left and 3.93±1.43 mm on the right. Wilcoxon matched‐pairs signed rank tests revealed no significant difference among sides (p=0.325). This report also addresses differences among the x, y, and z axes. These preliminary data demonstrate the utility of three‐dimensional analysis for the assessment of IOF location. Understanding the location of the IOF in three dimensions may aid in determining the best patient‐specific approach for infraorbital nerve block.Support or Funding InformationWV Research Challenge Fund [HEPC.dsr.17.06] and [HEPC.dsr.14.13]This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Infraorbital Foramen is Located between Nasospinale and Jugale

Identification of the infraorbital foramen (IOF) is important in infraorbital nerve block and the prevention of iatrogenic injury of the infraorbital nerve in maxillofacial surgeries. Though many methods have been proposed for identifying the location of the IOF, numerous inconsistencies exist among them. This study assessed the location of 1272 infraorbital foramina, from crania varied by age, sex, and geographic origin, relative to a midpoint of a line segment spanning from nasospinale to jugale (NS‐J). On average, the midpoint was located 1.92±1.85 mm (mean±SD) from the IOF. Most often, the midpoint was located either directly upon the IOF (Mode=0; 404:1272; 31.8%) or inferior to the IOF (403:1272; 31.7%). The NS‐J midpoint can be used to locate the infraorbital foramen in both females and males of varied geographic populations and ages regardless of craniofacial diversity. The results of this study may aid in the approach to infraorbital nerve block procedures and maxillofacial surgery.Support or Funding InformationWV Research Challenge Fund [HEPC.dsr.17.06] and [HEPC.dsr.14.13]This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Descriptive Morphometric Approach of the Skull and Mandible of the Common Opossum (Didelphis Marsupialis Linnaeus, 1758) in the Caribbean and its Clinical Application during Regional Anaesthesia.

The aim of this study was to determine the morphometric values of the skull and the mandible of the common opossum from the Caribbean island of Trinidad and Tobago. The skulls and mandibles were obtained from ten opossums captured for research purposes. The skulls and mandibles were prepared and cleaned using standard method. Some anatomical landmarks of the skulls and mandibles were identified and measured. The results were important for identification of the common opossum via comparison and discussion of our results with that of other marsupial species. Furthermore, the results had clinical importance with regard to regional nerve blocks of the infraorbital, inferior alveolar, and mental nerves for dental extraction and head surgery. This study concluded that by using the anatomical landmarks of the infraorbital and mental foramina it will be easier for the veterinarian surgeons during the application of local anesthetic agent for the infraorbital, inferior alveolar, and mental nerve blocks.

Comparing the anterior middle superior alveolar nerve block and infraorbital nerve block for maxillary anterior teeth anesthesia: A randomized clinical trial

ObjectiveTo compare the efficacy of the Anterior Middle Superior Alveolar nerve block with that of the Infra-orbital nerve block in achieving anesthesia in the anterior maxillary teeth. Study designWe recruited 62 patients who underwent vital tooth/teeth extraction under local anesthesia. We divided the patients into two groups: group A received Anterior Middle Superior Alveolar (AMSA) nerve block and group I received Infra-orbital nerve block (IONB). We assessed the Pulpal anesthesia by Pulp Tester with 0–10 digital reading, soft tissue anesthesia by pricking with periosteal elevator and injection pain using10 cm VAS (Visual Analogue Scale) score. We entered collected data in Microsoft excel 2010 and categorical variables analysed using Chi Square test and non-categorical variables analysed using Independent t (parametric) and Mann Whitney U (non-parametric) tests. ResultsWe achieved significantly higher pulpal anesthesia with infra-orbital nerve block for canine (p = .04) and 1st premolar (p = .02) as compared to anterior middle superior alveolar nerve block; but no significant difference was found in pulpal anesthesia for 2nd premolar, central and lateral incisors. The labial gingival anesthesia was significantly higher with infra-orbital nerve block than with anterior middle superior alveolar nerve block (p < 0.001). The VAS score in group I was 5.2 ± 2.1 (mean ± SD) and that in group A was 3.9 ± 1.3 (mean ± SD) which was statistically significant (p = .004). ConclusionAnterior middle superior alveolar nerve block resulted in inadequate pulpal and soft tissue anesthesia but less injection pain. Infra-orbital nerve block produced higher pulpal anesthesia for 1st premolar and canine but more injection pain.

The Infraorbital Foramen Is Located Midway Between the Nasospinale and Jugale: Considerations for Infraorbital Nerve Block and Maxillofacial Surgery.

Identification of the infraorbital foramen is important in infraorbital nerve block and the prevention of iatrogenic injury of the infraorbital nerve in maxillofacial surgeries. This study assessed the location of 887 infraorbital foramina from 518 adult crania of varied sex and population. The study assessed the midpoint of a line segment spanning from nasospinale to jugale (NS-J) relative to the infraorbital foramen. The mean distance of the NS-J midpoint from the infraorbital foramen was 2.1 ± 1.9 mm (mean ± SD) with a mode of 0 mm (266:887; 30%). The NS-J midpoint was located in the same plane or inferior to the infraorbital foramen in 98.4% of sides (873:887). There were no significant differences between sexes, populations, or sides with regard to the NS-J midpoint to infraorbital foramen distance. The NS-J midpoint can be used to locate the infraorbital foramen in both females and males of varied populations regardless of craniofacial diversity. The results of this study will aid in infraorbital nerve block procedures and maxillofacial surgery.

Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair

ObjectivesWe conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. MethodsSixty patients were randomly allocated into two groups (n=30), Group B received infra-orbital nerve block with 2mL of 0.25% Bupivacaine and Group BK received 0.5mg.kg−1 Ketamine for each side added to 1mL of 0.5% Bupivacaine solution diluted up to 2mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. ResultsPatients in Group BK showed lower postoperative FLACC scores during all recorded time points (p<0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p<0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67±45.67 vs. 240.0±0.0mg, p<0.04). The time to first oral intake was significantly reduced in Group BK (87.67±15.41 vs. 27.33±8.68min, p<0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45min (0.86±0.11 vs. 0.46±0.16, p<0.04) and in the first hour (h) postoperatively (1.40±0.17 vs. 0.67±0.14, p<0.003). Higher parent satisfaction scores were recorded in Group BK (p<0.04) without significant adverse effects. ConclusionsThe addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

Effects of ropivacaine combination with dexamethasone for bilateral infraorbital nerve block on postoperative analgesia and stress in pediatric patients with cleft lip repair

Objective This study was conducted to compare the effectiveness, advantages and disadvantages of bilateral infra orbital nerve block using ropivacaine combination with dexamethasone and dezocine for postoperative pain relief and stress level following cheiloplasty. Methods Sixty pediatric patients undergoing cheiloplasty were selected by simple random sampling and were divided into two groups(group B, group A). Group A patients were administered bilateral infra orbital nerve block with 0.25% ropivacaine 1 ml and 1 mg dexamethasone amount to 2 ml. Group B patients received dezocine 0.1 mg/kg iv. During postoperative period, postoperative agitation, CRIES scores(crying, required O2 for SpO2>95%, increased vital signs, expression, sleeplessness) at 2 h(T3), 4 h(T4), 6 h(T5), 8 h(T6), 12 h(T7), 24 h(T8) after surgery and adverse reaction were recorded as well. Supplementary analgesics using and duration between the administration of block/dezocine and the total dose of supplementary analgesics used within 24 h were noted. In order to detect plasma 1eve1 of cortisol(COR), norepinephrine(NE), epinephrine(E), patients blood were collected at time points before anesthesia(T1), at the end of surgery(T2), T6 and T8 after surgery. Results The score of agitation, the CRIES scores at each time point(4-12 h) and the total amounts of supplementary analgesics in group A were lower than in group B. Group A had lower nausea and vomiting rate than group B. Group A had lower concentrations of COR, NE, E at 8th hour than concentrations of group B. Conclusions Bilateral infra orbital nerve block using ropivacaine combination with dexamethasone provided effective postoperativeanalgesia for children with cleft lip repair and obviously extended analgesia duration. Moreover, this analgesia method effectively attenuated stress response caused by pain. Key words: Ropivacain; Dexamethasone; Infraorbital nerve; Nerve block; Cheiloplasty; Analgesia; Stress

Regional Nerve Blocks for Equine Dentistry.

Regional nerve blocks are necessary to facilitate equine oral surgery in the standing sedated patient. Step-by-step instruction on how to perform common regional nerve blocks are discussed, including infraorbital, maxillary, middle mental, and inferior alveolar nerve blocks. Regional nerve blocks are critical when performing dental procedures in the standing horse.1 The infraorbital and maxillary nerve blocks provide anesthesia of the infraorbital nerve, which is a branch of the maxillary nerve. Both nerve blocks provide adequate anesthesia for all maxillary dental procedures.1 When the infraorbital nerve block is utilized, care must be taken to advance the needle into the infraorbital foramen in order to appropriately anesthetize the caudal maxillary teeth. Mandibular dental procedures require anesthesia of the inferior alveolar nerve, which is a branch of the mandibular nerve. Local anesthesia at the level of the mental foramen will result in anesthesia of ipsilateral incisors and canines, while anesthesia at the level of the mandibular foramen will anesthetize the entire ipsilateral mandibular dental quadrant. All nerve blocks should have the injection site aseptically prepared prior to the procedure. The 4 most common dental nerve blocks are described step by step.

Anesthetic efficacy of the infraorbital nerve block in maxillary incisors and premolars using 2% lidocaine with epinephrine 1:80,000

Objectives: The authors conducted a clinical-trial, uncontrolled study to determine infraorbital nerve block effectiveness. Material and methods: Nineteen adult volunteers received 1.8 mL of lidocaine 2% with epinephrine 1:80,000 with an intraoral, infraorbital nerve block. Researchers used an electric pulp tester to measure pulp anesthesia in maxillary incisors and premolars. Participants reported soft tissue anesthesia and discomfort during the injection procedure; anesthesia onset time and its duration were also assessed and analyzed. Authors analyzed data using STATA statistical program 9®. Results: Most of the subjects in our trial were 21 years old (30%); the number of female participants (n = 12 - 60%) was greater than that of male participants. Authors evaluated pain perception when injecting anesthesia with a visual analogue scale (VAS), fi nding that 57.9% of patients (n = 11) categorized the pain as moderate (in a scale of 3-6). When assessing anesthesia success, it was observed that a greater number of canine teeth and first premolars (57.9%, n = 9 - CI 95%) were anesthetized. The authors also observed a significant greater number of nonresponse (non-anesthetized) cases in central and lateral incisors (100-84.2%, respectively). Anesthesia onset was at 12 to 19 minutes, with canines exhibiting the largest number of anesthetized reports with 47.4%. There was a 100% incidence of subjective feeling of soft tissue anesthesia in lower eyelid skin, skin of the nose and skin of the upper lip. Authors noted that 100% of the subjects rated it as unpleasant (VAS). Conclusions: Infraorbital anesthesia technique achieved successful anesthesia in only 57.9% of upper canines and first premolars; it proved ineffective for anesthetizing central and lateral incisors. This was demonstrated after these teeth were evaluated using rigorous pulp vitality testing. Soft tissue anesthesia occurred and it was classified as uncomfortable. Authors consider that usefulness of infraorbital nerve block technique in dentistry was questionable.

Comparative Study of Preoperative Biateral Infraorbital Nerve Block with Peri Inscisional Infiltration for Post Operative Pain Relief in Cleft Lip Surgery

Comparative Study of Preoperative Biateral Infraorbital Nerve Block with Peri Inscisional Infiltration for Post Operative Pain Relief in Cleft Lip Surgery

A clinical study to determine the efficacy of 7 ppm dexmedetomidine as an adjuvant to 2% lignocaine in infraorbital nerve block

Dexmedetomidine is a selective alpha-2-adrenoceptor agonist used as an adjuvant for regional anaesthesia. We studied its efficacy as an adjuvant to lidocaine in infraorbital nerve block in 90 patients divided equally into three groups. The first group (control) was given 2% lidocaine 2ml only, the second, 2% lidocaine 2ml with dexmedetomidine 14μg peripherally (peripheral group), and the third, 2% lidocaine 2ml peripherally with dexmedetomidine 14μg systemically (systemic group). Onset of anaesthesia, duration of action, blood pressure, oxygen saturation, and heart rate were evaluated. The mean (SD) onset of action was faster in the peripheral group (185 (39.02) seconds) than in the others (control: 261.67 (67.02); systemic: 217.37 (34.86) seconds). The duration of action was longer in the peripheral group (124.87 (19.75) minutes) than in the others (control: 70.43 (13.62); systemic: 88.83 (20.63) minutes). Differences in blood pressure, oxygen saturation, and heart rate measured at different intervals were not significant. The addition of 7mg/L dexmedetomidine to lidocaine perineurally speeds up the onset of action and prolongs the duration of anaesthesia.