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Continuous mandibular nerve block for pain relief. A report of two cases

[Analgésie par blocage continu du nerf maxillaire inférieur. Étude de deux cas.]

From the Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

Address correspondence to: Dr. Baljit Singh, Associate Professor, Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110 001, India. E-mail: dr_baljit{at}yahoo.com or rasvin666{at}rediffmail.com

Purpose: Mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible.

Methods: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days.

Results: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted.

Conclusions: Continuous mandibular nerve block with 2–4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.

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