Background and aims This pilot clinical case series describes a technique of ultrasound guided blockade of second and third branches of the trigeminal nerve for facial surgery in geriatric patients.
Methods Five geriatric patients (4 females and 1 male), average age of 74.5 years, were indicated for facial tumor surgery at the Department of Surgery, Masaryk Hospital in Usti nad Labem. Written informed consent was obtained from all patients. Anesthesia was performed using ultrasound guided blockade of nerve temporalis and second branches of the trigeminal nerve in the fossa pterygopalatine (maxillary nerve), a novel technique developed at the Department of Anesthesiology, Perioperative and Intensive Care Medicine. the ultrasound guidance allowed for the visualization of the fossa pterygopalatine. Landmarks are the lateral lamina of the pterygoid process of the sphenoide bone. Visualization of the maxillary artery and other vascular structures before and during the spread of the local anesthetic reduced the likelihood of intravascular anesthetic administration. the blockade itself was induced by 5ml (nerve temporalis) and 7 ml 0.5% Marcaine to second branch of trigeminal nerve.
Results The blockade was successful in all five patients, allowing for spontaneous breathing and patient’s cooperation under mild sedation. Cardiovascular stability was excellent despite the high anesthetic risk.
Conclusions Blockade of maxillary nerve in the fossa pterygopalatine and temporalis nerve, branch of the third trigeminal nerve proved to be a technique suitable for facial surgery in high risk geriatric patients.
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