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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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Open Access 01-08-2009 | Reports of Original Investigations

Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery

Authors: Edward R. Mariano, MD, Deborah Watson, MD, Vanessa J. Loland, MD, Larry F. Chu, MD, Gloria S. Cheng, MD, Sachin H. Mehta, MD, Rosalita C. Maldonado, BS, Brian M. Ilfeld, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2009

Abstract

Purpose

While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery.

Methods

At a tertiary care university hospital, healthy adult subjects scheduled for outpatient nasal surgery were randomly assigned to receive bilateral infraorbital injections with either 0.5% bupivacaine (Group IOB) or normal saline (Group NS) using an intraoral technique immediately following induction of general anesthesia. All subjects underwent a standardized general anesthetic regimen and were transported to the recovery room following tracheal extubation. The primary outcome was the duration of recovery (minutes) from recovery room admission until actual discharge to home. Secondary outcomes included average and worst pain scores, nausea and vomiting, and supplemental opioid requirements.

Results

Forty patients were enrolled. A statistically significant difference in mean [SD] recovery room duration was not observed between Groups IOB and NS (131 [61] min vs 133 [58] min, respectively; P = 0.77). Subjects in Group IOB did experience a reduction in average pain on a 0–100 mm scale (mean [95% confidence interval]) compared to Group NS (−11 [−21 to 0], P = 0.047), but no other comparison of secondary outcomes was statistically significant.

Conclusions

When added to a standardized general anesthetic, bilateral IOB do not decrease actual time to discharge following outpatient nasal surgery despite a beneficial effect on postoperative pain.

Prabhu KP, Wig J, Grewal S. Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip. Scand J Plast Reconstr Surg Hand Surg 1999; 33: 83–7.PubMedCrossRef

Nicodemus HF, Ferrer MJ, Cristobal VC, de Castro L. Bilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children. Scand J Plast Reconstr Surg Hand Surg 1991; 25: 253–7.PubMedCrossRef

Bosenberg AT, Kimble FW. Infraorbital nerve block in neonates for cleft lip repair: anatomical study and clinical application. Br J Anaesth 1995; 74: 506–8.PubMedCrossRef

McAdam D, Muro K, Suresh S. The use of infraorbital nerve block for postoperative pain control after transsphenoidal hypophysectomy. Reg Anesth Pain Med 2005; 30: 572–3.PubMed

Rajamani A, Kamat V, Rajavel VP, Murthy J, Hussain SA. A comparison of bilateral infraorbital nerve block with intravenous fentanyl for analgesia following cleft lip repair in children. Paediatr Anaesth 2007; 17: 133–9.PubMedCrossRef

Molliex S, Navez M, Baylot D, Prades JM, Elkhoury Z, Auboyer C. Regional anaesthesia for outpatient nasal surgery. Br J Anaesth 1996; 76: 151–3.PubMed

Higashizawa T, Koga Y. Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. J Anesth 2001; 15: 136–8.PubMedCrossRef

Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999; 89: 1352–9.PubMedCrossRef

Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652–8.PubMedCrossRef

10.

Hadzic A, Arliss J, Kerimoglu B, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology 2004; 101: 127–32.PubMedCrossRef

11.

Hadzic A, Karaca PE, Hobeika P, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg 2005; 100: 976–81.PubMedCrossRef

12.

Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 2004; 99: 589–92.PubMedCrossRef

13.

Lynch MT, Syverud SA, Schwab RA, Jenkins JM, Edlich R. Comparison of intraoral and percutaneous approaches for infraorbital nerve block. Acad Emerg Med 1994; 1: 514–9.PubMed

14.

Suresh S, Wheeler M. Practical pediatric regional anesthesia. Anesthesiol Clin North America 2002; 20: 83–113.PubMedCrossRef

15.

Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97: 62–71.PubMedCrossRef

16.

Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs 1998; 13: 148–55.PubMedCrossRef

17.

Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999; 89: 75–9.PubMedCrossRef

18.

Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 2001; 95: 1356–61.PubMedCrossRef

19.

Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4: 407–14.PubMedCrossRef

20.

Korttila KT, Jokinen JD. Timing of administration of dolasetron affects dose necessary to prevent postoperative nausea and vomiting. J Clin Anesth 2004; 16: 364–70.PubMedCrossRef

21.

Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94: 149–58.PubMedCrossRef

22.

Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 2002; 95: 627–34.PubMedCrossRef

23.

Edler AA, Mariano ER, Golianu B, Kuan C, Pentcheva K. An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy. Anesth Analg 2007; 104: 784–9.PubMedCrossRef

24.

Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005; 101: 1634–42.PubMedCrossRef

25.

Shirakami G, Teratani Y, Namba T, Hirakata H, Tazuke-Nishimura M. Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia. J Anesth 2005; 19: 93–101.PubMedCrossRef

26.

Seago JA, Weitz S, Walczak S. Factors influencing stay in the postanesthesia care unit: a prospective analysis. J Clin Anesth 1998; 10: 579–87.PubMedCrossRef

27.

Williams BA, Kentor ML, Vogt MT, et al. Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology 2004; 100: 697–706.PubMedCrossRef

28.

Williams BA, Kentor ML, Williams JP, et al. PACU bypass after outpatient knee surgery is associated with fewer unplanned hospital admissions but more phase II nursing interventions. Anesthesiology 2002; 97: 981–8.PubMedCrossRef

29.

Recart A, Issioui T, White PF, et al. The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: a dose-ranging study. Anesth Analg 2003; 96: 1631–5.PubMed

30.

Issioui T, Klein KW, White PF, et al. The efficacy of premedication with celecoxib and acetaminophen in preventing pain after otolaryngologic surgery. Anesth Analg 2002; 94: 1188–93.PubMedCrossRef

31.

Demiraran Y, Ozturk O, Guclu E, Iskender A, Ergin MH, Tokmak A. Vasoconstriction and analgesic efficacy of locally infiltrated levobupivacaine for nasal surgery. Anesth Analg 2008; 106: 1008–11.PubMedCrossRef

Title: Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery
Authors: Edward R. Mariano, MD
Deborah Watson, MD
Vanessa J. Loland, MD
Larry F. Chu, MD
Gloria S. Cheng, MD
Sachin H. Mehta, MD
Rosalita C. Maldonado, BS
Brian M. Ilfeld, MD
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2009
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-009-9119-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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