Continuous Maxillary and Mandibular Nerve Block for Perioperative Pain Relief: The Excision of a Complicated Pleomorphic Adenoma

Abstract

A 68-yr-old hypertensive patient with ischemic heart disease and intractable atrial fibrillation with stable hemodynamics and poor chest compliance underwent pleomorphic adenoma of the parotid gland using regional anesthesia with continuous propofol sedation. Continuous maxillary and mandibular nerve blocks were performed and excision was performed with complete intraoperative and postoperative pain relief without compromising the patient's hemodynamic variables.

Nerve Blocks Utilized in The Face: A Comprehensive Review

“…To avoid damaging the branches of the external carotid artery (eg, internal maxillary artery), the needle must be handled carefully. [11][12][13]…”

“…The insertion site is on a hypothetical line that is traced from the coronoid notch to the deepest portion of the pterygomandibular raphe. 13 Several alternative approaches have been described for the IANB, which aimed to achieve a higher success rate, reduce the risk of intravascular injections and nerve damage. 16,19-22…”

“…Also, care must be taken to ensure that the needle does not go too far and injure the globe, particularly in children where the maxilla is quite short. [11][12][13]…”

Ultrasound-guided trigeminal nerve block for faciomaxillary surgeries

“…Adequate pain relief perioperatively is important for the patient's early and smooth recovery and uneventful postoperative course. [1] Blocking of maxillary and mandibular nerve helps in the adequate management of pain. We present a case of maxillary fracture wherein ultrasound-guided injection in pterygopalatine fossa helped us to achieve adequate analgesia perioperatively.…”

Mandibular nerve block for peri‐operative pain relief using a peripheral nerve stimulator

“…Following written informed consent for the block, we administered 1 mg midazolam and 80 μg fentanyl intravenously. Under strict asepsis and after infiltration with lidocaine 1%, we inserted a 22‐G, 10‐cm insulated short‐beveled needle (Stimuplex A, B. Braun, Melsungen, Germany), with a guard at 6 cm, via the lateral extra‐oral approach [1]. We set the initial current at 1.3 mA, with a frequency of 2 Hz (Stimuplex DIG, B. Braun, Melsungen, Germany).…”