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Pre-surgical regional blocks in orthognathic surgery: prospective study evaluating their influence on the intraoperative use of anaesthetics and blood pressure control

  • Y.A. Chen
    Affiliations
    Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
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  • C.M. Rivera-Serrano
    Affiliations
    Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
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  • C. Chen
    Affiliations
    Department of Anaesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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  • Y.R. Chen
    Correspondence
    Address: Yu-ray Chen, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 123, Dinghu Road, Gueishan Township, Taoyuan 333, Taiwan. Tel: +886 3 3281200x3369; Fax: +886 3 3285507.
    Affiliations
    Craniofacial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Craniofacial Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
    Search for articles by this author
Published:January 19, 2016DOI:https://doi.org/10.1016/j.ijom.2015.09.014

      Abstract

      In orthognathic surgery, maxillary (CNV2) and mandibular (CNV3) divisions of the trigeminal nerve can be blocked successfully prior to surgery. In this study, it was hypothesized that regional blocks (nerve block over a particular region: bilateral CNV2 and CNV3 divisions of the trigeminal nerve) would decrease the total requirement for intraoperative anaesthetic agents and facilitate the process of hypotensive anaesthesia. Local anaesthesia containing 1/100,000 epinephrine and 10 ml 0.5% levobupivacaine was injected into the planned incisions in 50 patients. Twenty-five patients (group A) underwent orthognathic surgery without regional blocks and another 25 patients (group B) underwent surgery with regional blocks. The anaesthetic protocol was the same in both groups and administered by a single anaesthesiologist. The mean arterial pressure was recorded at several points throughout the operation, as well as all the medications used. The blood loss and the amounts of medications administered were lower in group B than in group A. In patients receiving regional blocks, the amounts of fentanyl and nicardipine required were significantly lower. The use of pre-emptive anaesthesia in orthognathic surgery may reduce the overall amounts of medications required for hypotensive anaesthesia, facilitate the intraoperative control of blood pressure, and decrease intraoperative blood loss.

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