&lt;p&gt;Effects of Adding a Combined Infraorbital and Infratrochlear Nerve Block to General Anaesthesia in Septorhinoplasty&lt;/p&gt;

Kaçar, Cem Kıvılcım; Uzundere, Osman; Salık, Fikret; Akgündüz, Mesut; Bıçak, Esra Aktiz; Yektaş, Abdülkadir

doi:10.2147/jpr.s255720

Cited by 6 publications

(7 citation statements)

References 26 publications

(66 reference statements)

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“…They found that the SPG group had significantly reduced pain, reduced analgesic use, and improved patient satisfaction compared to the placebo arm 14 . Similar findings have been shown with an infratrochlear and infraorbital nerve block 15 for septorhinoplasty. These intraoperative nerve blocks should be considered in the OSA population to reduce the need for opioids and other sedating medications in the perioperative period.…”

Section: Accepted Manuscriptsupporting

confidence: 86%

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

Coviello

Sivam

2023

Facial Plast Surg

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Obstructive sleep apnea (OSA) and nasal obstruction are common in the general population and frequently treated by otolaryngologists and facial plastic surgeons. Understanding the appropriate pre-, peri-, and postoperative management of OSA patients undergoing functional nasal surgery is important. OSA patients should be appropriately counseled in the preoperative period on their increased anesthetic risk. In OSA patients who are continuous positive airway pressure (CPAP) intolerant, the role of drug induced sleep endoscopy (DISE) should be discussed with the patient and depending on the surgeon’s practice may prompt referral to a sleep specialist. Should multilevel airway surgery be indicated, it can safely be performed in most OSA patients. Surgeons should communicate with the anesthesiologist regarding an airway plan given this patient population’s higher propensity for having a difficult airway. Given their increased risk of postoperative respiratory depression, extended recovery time should be given to these patients and the use of opioids as well as sedatives should be minimized. During surgery, one can consider using local nerve blocks to reduce postoperative pain and analgesic use. After surgery, clinicians can consider opioid alternatives such as nonsteroidal anti-inflammatory agents (NSAIDs). Neuropathic agents, such as gabapentin, require further research in their indications for managing postoperative pain. CPAP is typically held for a period of time after functional rhinoplasty. The decision on when to restart CPAP should be individualized to the patient based on their comorbidities, OSA severity, and surgical maneuvers performed. More research would provide further guidance in this patient population to shape more specific recommendations regarding their perioperative and intraoperative course.

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Section: Accepted Manuscriptsupporting

confidence: 86%

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

Coviello

Sivam

2023

Facial Plast Surg

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“…In addition, early post-surgical trauma can negatively influence the surgical results, which is particularly concerning in procedures such as rhinoplasty that involve modifications of intricate nasal bones. Consequently, adopting a cautious approach to minimize the risks posed by trauma induced by agitation is crucial, particularly for patients subjected to these surgeries [ 11 ]. While the precise efficiency of infraorbital and/or infratrochlear nerve blocks in countering agitation is still under investigation, previous studies, such as that by Choi et al [ 8 ], indicate a strong link between pain and emergence agitation.…”

Section: Discussionmentioning

confidence: 99%

“… Comparison of preoperative infraorbital and/or infratrochlear nerve blocks versus placebo: mean difference in postoperative pain score ( A ), standard mean difference in amount of analgesic used ( B ), and odds ratio for frequency of analgesic drug use ( C ) [ 8 , 9 , 10 , 11 , 12 , 13 ]. …”

Section: Figurementioning

confidence: 99%

“…These two peripheral nerve blocks have been reported to facilitate pain management, reduce complications, and reduce anesthetic agent consumption after nasal procedures. Conducting a nerve block of this nerve has been shown to promote effective pain control, reduce complications, and decrease the requirement for anesthetic agents following nasal surgeries [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis

Kim,

Park,

Kim

et al. 2023

Medicina

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Background and Objectives: Through a comprehensive meta-analysis of the pertinent literature, this study evaluated the utility and efficacy of perioperative infraorbital and/or infratrochlear nerve blocks in reducing postoperative pain and related morbidities in patients undergoing septorhinoplasty. Materials and Methods: We reviewed studies retrieved from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to August 2023. The analysis included a selection of seven articles that compared a treatment group receiving perioperative infraorbital and/or infratrochlear nerve blocks with a control group that either received a placebo or no treatment. The evaluated outcomes covered parameters such as postoperative pain, the amount and frequency of analgesic medication administration, the incidence of postoperative nausea and vomiting, as well as the manifestation of emergence agitation. Results: The treatment group displayed a significant reduction in postoperative pain (mean difference = −1.7236 [−2.6825; −0.7646], I2 = 98.8%), as well as a significant decrease in both the amount (standardized mean difference = −2.4629 [−3.8042; −1.1216], I2 = 93.0%) and frequency (odds ratio = 0.3584 [0.1383; 0.9287], I2 = 59.7%) of analgesic medication use compared to the control. The incidence of emergence agitation (odds ratio = 0.2040 [0.0907; 0.4590], I2 = 0.0%) was notably lower in the treatment group. The incidence of postoperative nausea and vomiting (odds ratio = 0.5393 [0.1309; 2.2218], I2 = 60.4%) showed a trend towards reduction, although it was not statistically significant. While no adverse effects reaching statistical significance were reported in the analyzed studies, hematoma (proportional rate = 0.2133 [0.0905; 0.4250], I2 = 76.9%) and edema (proportional rate = 0.1935 [0.1048; 0.3296], I2 = 57.2%) after blocks appeared at rates of approximately 20%. Conclusions: Infraorbital and/or infratrochlear nerve blocks for septorhinoplasty effectively reduce postoperative pain and emergence agitation without notable adverse outcomes.

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“…The results of Wang et al, (2015) study showed that general anesthesia with infraorbital nerve block was detected to be effective in decrement of using isoflurane and also decreasing the severity of postoperative pain sinus endoscopic surgery. Kaçar et al, (2020) showed that bilateral infraorbital nerve and infraoptic nerve blocks in septorhinoplasty were detected to be a simple, efficacious, and reliable technique the treatment of postoperative pain. Choi et al, (2019) performed bilateral infraorbital nerve and infratrochlear nerve blocks 30 minutes before septorhinoplasty for postoperative analgesia.…”

Section: Medical Science L Analysis Articlementioning

confidence: 99%

The effect of bilateral infraorbital nerve block on hemodynamic changes during sinus endoscopic surgery

Valeh¹,

Doroodian²,

Salajegheh³

et al. 2022

Medical Science

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Background: The present study examined the effect of bilateral infraorbital nerve block with marcaine on hemodynamic changes during sinus endoscopic surgery. Material and Methods: 30 patients underwent sinus endoscopy surgery in two groups: marcaine and normal saline. Ifraorbital nerve block was performed in the first group by injecting 1 ml of 0.5% marcaine for 30 to 40 seconds and in the second group by injecting 1 ml of sterile normal saline. The level of oxygen, pulse rate, and systolic and diastolic blood pressure were measured before anesthesia, 30 minutes and 60 minutes after anesthesia, at the time of completion of recovery surgery and exit from recovery. Results: The mean age of men was 37.29±10.15 and the mean age of women was 38.92±7.60. The mean systolic blood pressure of the marcaine group was less in comparison with the normal saline group 30 minutes (p = 0.001) and 60 minutes after the start of the anesthesia process, as well as at the time of surgery, at the time of entering the recovery and at the time of leaving the recovery (p <0.001). The mean pulse rate of marcaine group was less than normal saline group 30 minutes (p = 0.005) and 60 minutes (p = 0.019) after the start of anesthesia and at the end of surgery (p = 0.007). Conclusion: Bilateral infraorbital nerve block with topical injection of marcaine has a greater effect on lowering systolic and diastolic blood pressure and pulse than normal saline injection.

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<p>Effects of Adding a Combined Infraorbital and Infratrochlear Nerve Block to General Anaesthesia in Septorhinoplasty</p>

Cited by 6 publications

References 26 publications

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

Considerations for Functional Nasal Surgery in the Obstructive Sleep Apnea Population

Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis

The effect of bilateral infraorbital nerve block on hemodynamic changes during sinus endoscopic surgery

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