Infraorbital and infratrochlear nerve blocks combined with general anaesthesia for outpatient rhinoseptoplasty: A prospective randomised, double-blind, placebo-controlled study

Anaesth Crit Care Pain Med. 2016 Feb;35(1):31-36. doi: 10.1016/j.accpm.2015.09.002. Epub 2015 Nov 5.

Abstract

Introduction: We conducted a study to determine the efficacy of bilateral extraoral infraorbital and infratrochlear nerve blocks during outpatient rhinoseptoplasty under general anaesthesia.

Patients and methods: In this prospective, double-blind, randomised, controlled trial, 40 adult patients undergoing outpatient rhinoseptoplasty under general anaesthesia were assigned to receive bilateral infraorbital and infratrochlear nerve blocks with either 10mL of 0.25% levobupivacaine (Group LB) or isotonic saline (control group). Patients in Group LB received 0.1mL/kg of isotonic saline as a placebo and patients in the control group received 0.1mL/kg of morphine. The primary endpoint was total perioperative morphine consumption (intraoperative and in the post-anaesthesia care unit). The secondary endpoints were pain scores, time spent in the post-anaesthesia care unit and the outpatient ward, block-related complications and patient satisfaction.

Results: The total dose of perioperative morphine was lower in Group LB than in the control group (2.5±2.8mg versus 9.5±3.5mg, respectively, P<0.001). The mean±SD or median [IQR] times spent in the post-anaesthesia care unit (60±10min and 78±33min, respectively, P<0.03) and in the outpatient ward (210 [178-223] min versus 275 [250-300] min, respectively, P<0.001) were lower in Group LB than in the control group. There were no differences between groups for other endpoints.

Conclusion: Bilateral extraoral infraorbital and infratrochlear nerve blocks performed with 0.25% levobupivacaine during general anaesthesia combining remifentanil and desflurane reduce the perioperative dose of morphine and the time spent in the post-anaesthesia care unit and the outpatient ward in adult patients undergoing outpatient rhinoseptoplasty.

Keywords: Facial nerve block; Infraorbital; Infratrochlear; Levobupivacaine; Outpatient; Rhinoplasty.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Anesthesia, General / methods*
  • Anesthetics, Local
  • Bupivacaine / analogs & derivatives
  • Double-Blind Method
  • Endpoint Determination
  • Female
  • Humans
  • Levobupivacaine
  • Male
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / therapeutic use
  • Nasal Septum / surgery
  • Nerve Block / adverse effects
  • Nerve Block / methods*
  • Orbit*
  • Outpatients
  • Patient Satisfaction
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Rhinoplasty / methods*
  • Trochlear Nerve*

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Morphine
  • Levobupivacaine
  • Bupivacaine