2017-18 HSC Section 3 Green Book

Reprinted by permission of Anaesth Crit Care Pain Med. 2016; 35(1):31-36.

Anaesth

Crit

Care

Pain Med

35

(2016)

31–36

Original

Article

Infraorbital anaesthesia randomised,

and

infratrochlear

nerve

blocks

combined with

general

for

outpatient

rhinoseptoplasty: placebo-controlled

A

prospective

study §

double-blind,

Boselli a , b , * ,

Bouvet a ,

Augris-Mathieu a , Ge´ rard

Be´ gou a ,

Emmanuel

Lionel

Caroline

Nathalie Diot-Junique a , Najia

Rahali a , Delphine

Vertu-Ciolino c ,

Ce´ cile Ge´ rard d ,

Pivot d ,

Franc ¸ ois Disant b , c ,

Allaouchiche a , b

Bernard

Christine

a Department

of

anaesthesiology

and

intensive

care,

E´ douard-Herriot

hospital, Hospices

Civils

de

Lyon,

Lyon,

France

b Claude-Bernard

Lyon

I

university,

university

of

Lyon,

Lyon,

France

c Department d Department

of

otolaryngology-head

and

neck

surgery,

E´ douard-Herriot

hospital, Hospices

Civils

de

Lyon,

Lyon,

France

of

pharmacy,

E´ douard-Herriot

hospital, Hospices

Civils

de

Lyon,

Lyon,

France

A

R

T

I

C

L

E

I

N

F

O

A

B

S

T

R

A

C

T

Article

history:

Introduction: We infratrochlear

conducted

a

study

to

determine

the

efficacy

of

bilateral

extraoral

infraorbital

and

online

5 November

2015

Available

nerve

blocks

during

outpatient

rhinoseptoplasty

under

general

anaesthesia.

In

this

prospective,

double-blind,

randomised,

controlled

trial,

40

adult

patients bilateral

and methods:

Patients

Keywords: Infraorbital Infratrochlear Facial nerve

outpatient

rhinoseptoplasty

under

general

anaesthesia were

assigned

to

receive

undergoing infraorbital

and

infratrochlear

nerve

blocks with

either

10 mL

of

0.25%

levobupivacaine

(Group

LB)

or

(control group). Patients

in Group LB received 0.1 mL/kg of

isotonic saline as a placebo and

isotonic saline

block

in

the

control

group

received

0.1 mL/kg

of

morphine.

The

primary

endpoint

was

total

patients

Outpatient Rhinoplasty Levobupivacaine

morphine

consumption

(intraoperative

and

in

the

post-anaesthesia

care

unit).

The

perioperative

endpoints were pain

scores,

time

spent

in

the post-anaesthesia

care unit

and

the outpatient

secondary

block-related

complications

and

patient

satisfaction.

ward,

The

total

dose

of perioperative morphine was

lower

in

Group

LB

than

in

the

control

group

Results:

2.8 mg

versus

9.5

3.5 mg,

respectively,

P < 0.001).

The mean

SD

or median P < 0.03)

[IQR]

times

spent

in

(2.5

post-anaesthesia

care

unit

(60

10 min

and

78

33 min,

respectively,

and

in

the

outpatient

the

(210

[178–223] min versus 275

[250–300] min,

respectively, P < 0.001) were

lower

in Group LB

than

in

ward

control

group.

There were

no

differences infraorbital

between

groups

for

other

endpoints.

the

Bilateral

extraoral

and

infratrochlear

nerve

blocks

performed desflurane

with

0.25%

Conclusion:

during

general

anaesthesia

combining

remifentanil

and

reduce

the

levobupivacaine

the

time

spent

in

the post-anaesthesia

care unit and

the outpatient

perioperative dose of morphine and

in

adult

patients

undergoing

outpatient

rhinoseptoplasty.

ward

2015

Socie´te´ franc ¸ aise

d’anesthe´sie

et

de

re´animation

(Sfar).

Published

by

Elsevier Masson

SAS.

All

reserved.

rights

1. Introduction

reporting pain

scores

of > 3

on

a

0–10 numerical

rating

scale

and

almost 30% of patients reporting pain scores of 6

[1,2] . The recent

guidelines

issued acute

by

the

American

Society

of

Anesthe-

practice siologists setting regional suggested

common minor

to medium

level

surgical

procedures

Several

(ASA)

for

pain management

in

the

perioperative

in unexpectedly high

levels of postoperative pain. This is

still result

recommend

the use of multimodal analgesia and

the use of

case

for

rhinoplasty

or

rhinoseptoplasty, with

45%

of

patients

the

blockades

whenever

possible

[3] .

It

has

also

been

that

regional analgesic

analgesia therapy

techniques

should

be

used

as

§ This

study was

presented

in

part

at

the

French

Society

of Anesthesiology

and

first-line

in

plastic

surgery

procedures

the [4] .

Care

(Sfar)

annual meeting,

September

2014,

Paris,

France.

Intensive

Facial

nerve

blocks

may

be

used

during

outpatient

nasal

* Corresponding

author.

Service 69003

d’anesthe´sie-re´animation,

hoˆpital

E´ douard-

although

a

duration

of

surgery

exceeding

sixty minutes their use as a

surgery,

5,

place

d’Arsonval,

Lyon,

France.

Tel.:

+33

4

72

11

69

88.

Herriot,

in

the nasopharynx may

limit

and excessive bleeding

emmanuel.boselli@chu-lyon.fr

(E.

Boselli).

address:

E-mail

http://dx.doi.org/10.1016/j.accpm.2015.09.002 2352-5568/ 2015 Socie´te´ franc ¸ aise d’anesthe´sie et de

re´animation

(Sfar).

Published

by

Elsevier Masson

SAS.

All

rights

reserved.

246