Bilateral ultrasound-guided maxillary and mandibular combined nerves block reduces morphine consumption after double-jaw orthognathic surgery: a randomized controlled trial

Regional Anesthesia & Pain Medicine Pub Date : 2024-05-02 DOI:10.1136/rapm-2024-105497

Thomas Esquerré, Marion Mure, Vincent Minville, Alice Prevost, Frédéric Lauwers, Fabrice Ferré

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Abstract

Background Double-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery. Methods In this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Results Compared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of −20.1 (95% CI −37.4 to −2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of −28.7 (95% CI −55.9 to −1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson’s correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively). Conclusion Bilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery. Trial registration number [NCT05351151][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05351151&atom=%2Frapm%2Fearly%2F2024%2F05%2F02%2Frapm-2024-105497.atom

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双侧超声引导下的上颌和下颌联合神经阻滞可减少双颌正颌手术后的吗啡用量：随机对照试验

背景众所周知，双颌手术疼痛难忍，需要使用阿片类药物。上颌（V2）和下颌（V3）神经阻滞可提供充分的镇痛效果，且与阿片类药物相关的副作用最小。我们的主要目的是评估双侧超声引导下 V2 和 V3 神经联合阻滞对双颌正颚手术患者的镇痛效果。方法在这项单盲随机对照研究中，50 名患者被前瞻性地分配到双侧超声引导下 V2 和 V3 神经联合阻滞或口内浸润局麻药。主要结果是术后第 1 天评估的累积口服吗啡当量（OME）消耗量。次要结果是恢复室和术后第 2 天的累积 OME 消耗量和疼痛评分、术中麻醉剂消耗量以及阿片类药物相关副作用。阿姆斯特丹术前焦虑和信息量表（APAIS）调查了术前焦虑。结果与浸润相比，超声引导区域麻醉减少了第1天（45.7±37.6 mg vs 25.5±19.8 mg，平均差异为-20.1 (95% CI -37.4 to -2.9) mg，p=0.023）和第2天（64.5±60 mg vs 35.8±30.2 mg，平均差异为-28.7 (95% CI -55.9 to -1.43) mg，p=0.040）的累积阿片类镇痛药消耗量。有趣的是，第 2 天最严重疼痛评分和累计 OME 消耗量与 APAIS 呈正相关（皮尔逊相关系数分别为 0.42（P=0.003）和 0.39（P=0.006））。结论双侧超声引导下 V2 和 V3 神经联合阻滞可将双颌手术患者的术后阿片类药物用量减少约 50%。试验注册号[NCT05351151][1]。如有合理要求，可提供相关数据。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05351151&atom=%2Frapm%2Fearly%2F2024%2F05%2F02%2Frapm-2024-105497.atom

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Regional Anesthesia & Pain Medicine

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