ESRA Academy. Saura Henriques da Silva C. Sep 8, 2016; 138440; 0290 Topic: Head and Neck Blocks
César Saura Henriques da Silva
César Saura Henriques da Silva

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Background and Aims:

Orthognathic surgery frequently produces strong noxious stimulation. Mandibular and maxillary nerve blocks offer excellent postoperative analgesia with little adverse effects. We evaluated its efficiency for postoperative analgesia in maxillary and mandibular osteoplasty.


A 23-year-old woman, ASA physical status 1, scheduled for maxillary and mandibular osteoplasty for micrognathia correction. General anesthesia was induced using propofol, fentanyl and rocuronium. The airway was secured with nasotracheal intubation. Maintenance of anesthesia was with 50:50 O2 and air with sevoflurane. Additional fentanyl boluses were administered as required to maintain hemodynamic stability. Intraoperative analgesia was complemented with paracetamol and metamizol, which were continued for postoperative analgesia, and morphine (3mg). Ondansetrom and dexamethasone were given for prophylaxis of postoperative nausea and vomiting. The procedure lasted 5 h and was uneventful. At the end of the procedure both blocks were performed. SMB under echographic guidance with 0.15 ml/kg of 0.375% ropivacaine on each side and GMB with 2 ml of 0.375% ropivacaine on each side (50 mm, 22 Gauge needle). Pain scores were evaluated by numerator rating scale every 3 hours for the first 24 h, and then twice daily for 72h. Administration of rescue analgesics and adverse effects were recorded during the same period.


Pain scores were 0/10 for the first 24h. Maximal pain score during the 72h period was 2/10. The patient did not require rescue analgesics. No complications related to the blocks were recorded.


From this case report this seems to be an effective alternative for postoperative analgesia, reducing opioid administration and improving patient comfort.  

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