The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study

Mane S, Girija A. SCPNB is an adjuvant to local anaesthesia for maxillofacial surgical practice

The superficial cervical plexus nerve block [SCPNB] procedure is frequently used throughout head and neck surgery because it is simple to learn and has a low rate of complications. The investigation of this method might produce superior outcomes in treating frequent maxillofacial disorders including mandibular fractures and infections of the odontogenic region. The SCPNB is known to play a part in the medical evacuation of head and neck abscesses, the excision of superficial diseases in the perimandibular region, and the therapy of mandibular fracture, despite the dearth of research in this area. Considering this background, it was expected that the SCPNB might be helpful as an adjuvant to regional anaesthesia in maxillofacial surgery. The purpose of this study was to assess the effectiveness of the SCPNB in the treatment of mandibular fractures and infectious diseases in the perimandibular area. 48 patients with either submandibular space infections or mandibular injuries who were anticipated for surgical procedure under regional anaesthesia participated in a prospective randomized clinical study (eg, inferior alveolar nerve block, long buccal nerve block). Administering a combination of a local infiltration and regional anaesthesia was used as the control group. Regional anaesthesia and a SCPNB were administered to the intervention class. The following factors were examined: pain, anaesthesia's duration and onset, waiting period before initial analgesic demand, pulse rate, and blood pressure. The unpaired t-test was used to compare groups. Multiple variables ANOVA (for more than two observations) was used for intragroup analysis, accompanied by a post-hoc analysis of variance. In aspects of intra - operative pain at thirty minutes, time required of anaesthesia, intraoperative anesthetic necessity, duration until first analgesic recommendation, and intra - operative diastolic arterial blood pressure at ten minutes, the SCPNB group demonstrated a substantial (P ≤.01) improved performance. It can be concluded that the use of a regional anaesthetic approach in conjunction with a SCPNB is a good substitute to localized infiltration for patients having surgery for fracture of mandible and perimandibular area infections.

Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study

INTRODUCTION

In the present study, the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeries by observing intra- and postoperative requirements of the total dose of the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed.

MATERIALS AND METHODS

Sample size was calculated using reference by taking the parameter pain score at 12 hours using MedCalc software v. 19.5.1 (MedCalc Software, Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted.

RESULTS

Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28 mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min) with a p-value <0.0001. No significant complications were noted in any patient.

CONCLUSION

SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.

Abstract No.: ABS1074 : Evaluation of efficacy of superficial cervical plexus block for surgeries in head and neck region: A comparative randomised control study

Background and Aims:

Superficial cervical plexus block can provide analgesia in head and neck surgeries. This study aimed to evaluate analgesic efficacy of superficial cervical plexus block (SCPB) in various head and neck surgeries, with the primary objectives of assessing time to first rescue analgesic, total dose of rescue analgesics in 24 hours, intraoperative analgesic requirement and associated perioperative complications.

Methods:

Sixty patients of American Society of Anesthesiologists physical class II,III (30 patients in each group) were included. Group A received general anaesthesia(GA) with systemic analgesia and group B received GA followed by SCPB with injection bupivacaine 0.25% 10ml on each side according to site of surgery. Visual analogue scale(VAS) scores, intra and postoperative analgesic requirement in 24 hours, time of first rescue analgesic demand and peri-operative complications were noted. All quantitative data were analysed by student-t test and qualitative data was analysed by chi-square test.

Results:

Time of first rescue analgesia was earlier and intraoperative fentanyl requirement and postoperative total rescue analgesic requirement were higher in group A (32.33+_38.39, 38.33+_12.61, 2566.667 + _504.006) than group B(1092+_396.55 minutes, 10.66+_13.11, 833.33+_874.28 ) with p value <0.001 (table 1,2). No significant complication was noted in any patient.

Conclusion:

SCPB provides better perioperative analgesia and decreases intraoperative as well as postoperative analgesic requirements and associated side effects with no significant perioperative complications in various head and neck surgeries.

Superficial Cervical Plexus Block in Selective Cases of Oral and Maxillofacial Surgery as an Alternative to General Anesthesia: A Case Presentation

The superficial cervical plexus block (SCPB) is well acknowledged, accepted for regional anesthetic for the submandibular area, neck region, and ear lobe. It is a possible valuable anesthetic technique in individuals to be operated on with conditions such as ear lobe lacerations, submandibular abscesses, and trauma to the mandibular or the neck region. Its application in oral and maxillofacial surgery is for various surgical procedures in the peri-mandibular area, excision of superficial lesions in the mandibular, ear lobe, neck region, and suturing of the skin in the corresponding region. We illustrate a case of non-union of mandibular fracture operated under superficial cervical plexus block without any complications.

Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice

PURPOSE

Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections.

METHODS

A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals].

RESULTS

Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes.

CONCLUSION

It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.