Mandibular block

Methods: Sixty patients scheduled for unilateral mandibular fracture surgeries were randomly divided into two groups by computer-generated random numbers and sealed envelope method: Group A received UG mandibular nerve block before surgical incision and group B received after surgery with ropivacaine 0.5% 10ml. The anesthesiologist performing the case took no further part in the study. The second anesthesiologist, who was blinded to the group involved, monitored the patient in the post-anesthetic care unit (PACU). The patients as well as the statistician were not aware of the group assigned. The patients were started on patient-controlled analgesia (PCA) morphine with bolus 1mg and a lockout interval of 10min. The morphine consumption for 24h was recorded. The pain was assessed by the VAS score. The additional intraoperative fentanyl consumption and time for a request for rescue analgesic were recorded. Results: The total morphine consumption was reduced in group A (4.566±0.717mg) than group B (5.93±0.876mg) with a p-value of <0.0001. The time for a request for rescue analgesic was also prolonged in group A (794.08 ± 89.561min) than group B (505.333 ±73.159min). It was also statistically highly significant (p-value <0.0001). In group A, only four patients required an additional dose of fentanyl as against 11 patients in group B. The heart rate was also lower in group A 30min after the administration of the block and persisted for two hours intraoperatively.方法： 将60例拟行单侧下颌骨骨折手术的患者通过计算机生成随机数结合密封信封法随机分为两组：A组于手术切皮前接受UG下颌神经阻滞，B组于术后给予0.5%罗哌卡因10ml。实施该手术麻醉的麻醉医师不参与本研究的后续工作。第二位对分组情况不知情的麻醉医师在麻醉恢复室（Post-Anesthesia Care Unit, PACU）对患者进行监护。患者及统计师均对分组分配情况不知情。患者术后采用吗啡患者自控镇痛（Patient-Controlled Analgesia, PCA）模式，单次推注剂量1mg，锁定间隔为10分钟。记录患者24小时内的吗啡总使用量，采用视觉模拟评分法（Visual Analogue Scale, VAS）评估疼痛程度，同时记录术中追加芬太尼的剂量以及首次请求补救镇痛的时间。 结果： A组吗啡总使用量（4.566±0.717mg）显著低于B组（5.93±0.876mg），差异具有极强统计学意义（p<0.0001）。A组首次请求补救镇痛的时间（794.08±89.561min）显著长于B组（505.333±73.159min），差异同样具有极强统计学意义（p<0.0001）。A组仅4例患者需追加芬太尼剂量，而B组有11例患者需追加。神经阻滞后30分钟，A组患者心率低于B组，且该心率差异在术中持续2小时。