Successful use of combined mental nerve block and superficial cervical plexus block for mental debridement in a patient with impaired cardiac function

Abstract

Anesthesia in patients with decreased cardiac function is a challenge for anaesthesiologists, as patients with poor cardiac function are more prone to hemodynamic instability. Anaesthesiologists must conduct a thorough evaluation and select the most suitable anaesthetic management. In patients with impaired cardiac function undergoing head and neck surgeries, regional anaesthesia with a peripheral nerve block is often preferred. A 59-year-old male patient with a history of heart failure, coronary artery disease (CAD), and type 2 diabetes mellitus (T2DM) was diagnosed with a mentum abscess. Echocardiography revealed a low systolic ejection fraction (LVEF 19%). For this patient, debridement of the mentum was planned, using a combination of mental nerve block and superficial cervical plexus block for anaesthesia. No complications or hemodynamic instability were observed during the perioperative or postoperative periods. Regional anaesthesia was chosen due to its lower risk of instability compared to general anaesthesia in patients with poor heart function. The surgical area involved the mentum and neck, so a combination of mental nerve block and cervical plexus block was appropriate. Since debridement requires rapid onset and adequate duration of anaesthesia, a mix of 2% lidocaine and 0.75% ropivacaine was used.

Abbreviations: CAD: coronary artery disease, EF: Ejection fraction, HF: Heart failure, MACCE: major adverse cardiovascular and cerebrovascular events, MI: myocardial infarction, PCI: percutaneous coronary intervention, T2DM: type 2 diabetes mellitus,

Keywords: Decreased Cardiac Function; Low Ejection Fraction; Mental Nerve Block; Cervical Plexus Block; Regional Anesthesia

Citation: Ajie A, Alfaruq AU, Hakim L. Successful use of combined mental nerve block and superficial cervical plexus block for mental debridement in a patient with impaired cardiac function. Anaesth. pain intensive care 2025;29(5):418-423. DOI: 10.35975/apic.v29i5.2866

Received: April 16, 2025; Revised: June 14, 2025; Accepted: June 17, 2025