[Percutaneous mandibular nerve block using neuro-stimulation guiding through the sigmoid indentation in facial
F Espitalier1, A-F Dubost, D Goga
1Service d'Anesthésie-Réanimation II, Université François-Rabelais, hôpital Trousseau, CHU de Tours, 37044 Tours cedex 09, France. fabien.espitalier@univ-tours.fr
Introduction:
Mandibular nerve block is a simple and effective but rarely used technique. It decreases peri-operative pain in mandibular osteotomy. It improves surgical field visibility by decreasing bleeding. Mandibular nerve block allows cutaneous surgery without general anesthesia and is one of the alternative treatments for chronic facial pain.
Technical Note:
The mandibular nerve is located using a needle connected to a neurostimulator. After local disinfection, a neurostimulation needle is inserted below the zygomatic arch, between the coronoid apophysis in front, and the condyle process in back, with a 45 to 60° angle. The needle is pushed to a 40 mm depth. Masticator muscle contraction confirms mandibular nerve stimulation. After a careful negative aspiration, 5 mL of ropivacaine 0.5% are injected slowly, and in increments.
Discussion:
The complications with this technique, such as failure or arterial puncture, are rare and limited if a nerve stimulator is used. Patient's comfort is improved by intravenous remifentanil sedation in target control infusion mode, associated to prior use of prilocaine and lidocaine cutaneous cream.
