An Appropriate Setting for a Patient-Controlled Analgesia Pump for Continuous Local Anesthesia After Bimaxillary...

In this report, we aimed to describe an appropriate setting for a patient-controlled analgesia (PCA) pump for postoperative pain control using local anesthetic after bimaxillary osteotomy, which is considered a highly invasive procedure. We conducted a cadaver study to determine the appropriate flow rate setting and then applied our findings to a clinical case. We examined the distribution of local anesthetic administered as ultrasound-guided inferior alveolar nerve blocks (UGIANBs) at different volumes. Using the same UGIANB approach, we placed an indwelling catheter in a healthy male who had undergone bimaxillary osteotomy and set the PCA pump loaded with 0.2% ropivacaine to continuously administer local anesthetic at a flow rate of 7 mL/hour with an additional 5-mL bolus per activation and 30-minute lockout. The patient reported no postoperative pain, did not require other analgesics or antiemetics postoperatively, and had no complications. This approach may have a major impact on clinical practice as it enables opioid-free postoperative analgesia, which may accelerate patient recovery by reducing perioperative complications and shortening hospital stays.