Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach
- PDF / 10,580,897 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 12 Downloads / 138 Views
REPORTS OF ORIGINAL INVESTIGATIONS
Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach Bloc du nerf maxillaire e´choguide´ : une e´tude anatomique de l’approche supra-zygomatique . Vincent Chan, MD FRCPC FRCA . Jason T. Maynes, PhD . Gaston Echaniz, MD Yelda Jozaghi, MD . Anne Agur, PhD MSc BSc OT Received: 22 March 2019 / Revised: 17 June 2019 / Accepted: 17 June 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was to quantify the various angles and depth of the block needle, as well as to evaluate the impact of volume on the extent of injectate spread that might influence anesthetic coverage and blockrelated complications.
The work is to be attributed to Department of Surgery Vall d’Hebron Hospital, Universitat Auto`noma de Barcelona, Barcelona, Spain. G. Echaniz, MD (&) Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada e-mail: [email protected] Department of Anesthesiology, Vall d’ Hebron Hospital, Universitat Auto`noma de Barcelona, Passeig de Vall d’Hebron 119-129, 08035 Barcelona, Spain V. Chan, MD FRCPC FRCA Department of Anesthesia, Western Hospital, University of Toronto, Toronto, ON, Canada J. T. Maynes, PhD Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada Y. Jozaghi, MD Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada A. Agur, PhD MSc BSc OT Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
Methods Following an ultrasound-guided suprazygomatic MN block with dye injection, a dissection was performed in the pterygopalatine fossa (PPF) of four lightly embalmed cadaveric specimens. Half of the specimens were injected with 5 mL of dye, and the other half with 1 mL of dye. The needle depth was measured from the ultrasound images and using rubber markers. Following injection, dissection was performed to map the area of dye spread. Results The median [interquartile range (IQR)] distance from the skin to the PPF was 37 [36–43] mm and 47 [40– 50] mm by ultrasound and rubber marker methods, respectively. The median [IQR] needle orientation was 14 [11–32] degrees inferiorly and 15 [10–17] degrees posteriorly. The PPF was consistently dyed in the 5 mL group, but sporadically dyed in the 1 mL group. In the 5 mL group, spread outside of the PPF was seen. Conclusions We showed that 5 mL of injectate far exceeds the capacity of the PPF, leading to drug spread outside of the PPF. Moreover, we found that 1 mL of injectate largely covered the nerve, suggesting a more efficacious and safer block procedure. This finding will need confirmation in future clinical studies. Re´sume´ Objectif Bien qu’un bloc du nerf maxillaire semblerait fournir une analge´sie
Data Loading...
