Bilateral mandibular block improves pain relief and morphine consumption in mandibular osteotomies: a prospective, randomized, double-blind, placebo-controlled clinical trial

Abstract

BackgroundThe sensory innervation of the lower jaw mainly depends on the third root of the trigeminal nerve, the mandibular nerve (V3). The aim of this single-center, prospective, randomized, double-blind, placebo-controlled study was to evaluate the effectiveness of bilateral V3 block for postoperative analgesia management in mandibular osteotomies.Methods107 patients undergoing mandibular surgery (75 scheduled osteotomies and 32 mandible fractures) were randomized in two groups. A bilateral V3 block was performed in each group, either with ropivacaine 0.75% (block group, n=50) or with a placebo (placebo group, n=57). A postoperative multimodal analgesia was equally provided to both groups. The primary outcome was the cumulative morphine consumption at 24 hours. Secondary outcomes were the occurrence of severe pain and the incidence of postoperative nausea and vomiting (PONV) in the first 24 hours. Data were analyzed on an intention-to-treat basis.ResultsThe cumulative morphine consumption at 24 hours was significantly lower in the block group (median 8.0 mg (IQR 2.0–21.3) vs 12.0 mg (IQR 8.0–22.0), p=0.03), as well as the incidence of severe pain during the 24 hours of follow-up (4.0% vs 22.8%, p<0.01). The mandibular block had no impact on the incidence of PONV.ConclusionBilateral V3 block for mandibular osteotomies is an effective opioid-sparing procedure. It provided better postoperative analgesia in the first 24 hours, and it did not affect PONV incidence.Trial registration numberNCT02618993.

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

“…For patients undergoing bimaxillary surgery, ultrasound-guided trigeminal nerve block with 0.25% ropivacaine was effective in reducing intraoperative sufentanil and remifentanil consumption and decreasing the incidence of POV (20% vs. 40%, P = 0.028) [ 14 ]. A study by Bertuit et al [ 15 ] examined the role of bilateral mandibular block with 0.75% ropivacaine. Their results suggested that bilateral mandibular block effectively decreased morphine consumption but resulted in more incidence of PONV (46.0% vs. 21.1%, P < 0.01).…”

“…In this review, most studies revealed significantly lower incidences of PONV when combined nerve block with general anesthesia. However, Bertuit et al [ 15 ] reported conflicting findings. They found bilateral mandibular block was associated with a higher incidence of PONV, although postoperative morphine consumption was reduced.…”

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

“…Such results have already been described in a recent study evaluating the effectiveness of an ultrasound-guided mandibular nerve block. 16 Moreover, it has been demonstrated that PONV after orthognathic surgery is the result of a multiple factors interaction including age, gender, pain intensity, surgical duration, use of halogens, consumption of opioids…but is not correlated with anesthetic's experience. 30 Further studies are necessary to better understand the risk factor of PONV in double-jaw surgery.…”

The Intraoperative Adherence to Multimodal Analgesia of Anesthesiologists: A Retrospective Study

“…Prospective randomized clinical trials [9,10], retrospective cohort study [11,12], and metaanalysis [13,14] have reported that application of MMA is associated with improved pain control and less opioid consumption. However, although the benefit of MMA is obvious, adherence to MMA is not reported clearly, which determines the actual outcomes of surgical patients [4,15].…”