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19 Ultrassound-guided infrazygomatic maxillary nerve block: an alternative approach to maxillofacial surgery – a case report
  1. GS Sousa1 and
  2. A Vaz2
  1. 1Anesthesiology Resident from Centro Hospitalar Tondela-Viseu, Viseu, Portugal
  2. 2Assistant of Anesthesiology from Centro Hospitalar Tondela-Viseu, Viseu, Portugal


Background and Aims Nose surgical procedures are associated with moderate postoperative pain, being the first 24 hours the most intense pain period. A lower level of postoperative pain promotes better healing, decreases anxiety and increases patient’s comfort. Multimodal analgesia approach should be applied in order to provide maximum comfort while avoiding opioids adverse effects such as postoperative nausea and vomiting (PONV). PONV risk is exacerbated due to a passive blood flow that reaches the stomach during procedure.2 We report a case of an infrazygomatic maxillary nerve block (IZMNB) as part of multimodal analgesia for rhinoplasty surgery.

We intend to increase awareness to IZMNB as an effective analgesic technique for maxillofacial surgery.

Methods Case report and literature review.

Results A 28-year-old patient, ASA II, was admitted for a rhinoplasty and mentoplasty. Under general anesthesia, an ultrasound-guided IZMNB was performed bilaterally with ropivacaine 0.1%, 5cc each side, as part of a multimodal analgesic technique. Paracetamol and cetorolac were also administered. After emergence, patient referred low level of pain, needing only 2 mg of morphine at the post-anesthetic care unit, due to chin pain (glossopharyngeal nerve area).

Conclusions IZMNB mechanism of action relies on local anesthetic dispersion within the pterygopalatine fossa. The maxillary nerve block (second branch of the trigeminal nerve), at pterygopalatine fossa level, promotes effective analgesia to the middle third of the face.

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