Intravenous patients controlled analgesia versus maxillary nerve block in unilateral maxillary surgery

Abstract

Objective: The aim of the present study was to compare perioperative pain relief with intravenous
patient controlled analgesia using morphine and maxillary nerve block in patients undergoing unilateral
maxillary surgery.
Methodology: Sixty patients, ages between 17 and 70 years, ASA I and II, undergoing unilateral maxillary
surgery (cystectomy, odontogenic tumour excision and orodental fistula repair), were recruited in the
study and divided into two equal groups. In Group-A patients were administered general anesthesia plus
maxillary nerve block with bupivacaine, and in Group-B patients were anesthetized with general anesthesia
and morphine followed by PCA. Blood pressure, heart rate and SpO2 were measured intraoperatively
every 15 min. VAS was used postoperatively every 4 hours during first 24 hours. Satisfaction of the patient,
conscious level, and complications, e.g. nausea, vomiting, itching and urine retention, were recorded in
both groups.
Results are presented as mean ± standard deviation (SD). Statistical analysis was performed with SPSS
software version 16. The unpaired students t-test was used to compare the results of both groups.
Complications are presented as percentage. P value <0.05 is considered significant.
Results: The hemodynamic parameters were increased in group B in comparison to group A. No significant
changes in oxygen saturation during intraoperative period were observed between both groups or within
groups. Regarding pain score (VAS), there were no statistically significant difference between both groups
at (0) hour but difference was statistically significant between both groups after 4, 8, 12, 16, 20 and 24
hours, VAS score being more in Group B in comparison to Group A. Only 10% and 3.3% of patients in
Group A suffered from nausea and drowsiness respectively. In group B, 30%,10%, 10% , 20 %and 10% of
patients suffered from nausea, vomiting, Pruritus , drowsiness and urine retention respectively. This part
needs to be described in a better way.
Conclusion; Perioperative pain relief in cases of unilateral maxillary medium sized maxillary pathology
removal achieved by maxillary nerve block is better than intravenous patient controlled analgesia due to
hemodynamic stability, better pain control and lower side effects