To Compare the Analgesic Efficacy of Inferior Alveolar Nerve Block and Mandibular Nerve Block for Elective Unilateral Mandibular Fracture Surgery Under General Anaesthesia: A Randomised Comparative Study

Background: Mandibular fracture surgery is associated with significant perioperative nociceptive stimulation and opioid requirement even under general anaesthesia. Regional nerve block may improve analgesia and haemodynamic stability. Material and Methods: This randomized comparative study included 100 patients undergoing elective unilateral mandibular fracture surgery under general anaesthesia. Patients were divided into two groups of 50 each. Group A received inferior alveolar nerve block and Group M received mandibular nerve block using 0.5% bupivacaine. Baseline profile, intraoperative and postoperative haemodynamic variables, additional fentanyl requirement and adverse effects were compared. Results: Both groups were comparable for age, gender, BMI, ASA grade and duration of surgery. Intraoperative heart rate was significantly lower in Group M from incision time onwards. At 15 minutes, heart rate was 94.86 ± 12.18/min in Group A and 86.97 ± 9.36/min in Group M (p = 0.0004). MAP was also significantly lower in Group M at 30, 45 and 60 minutes. Postoperative heart rate and MAP were significantly lower in Group M at all recorded time points up to 6 hours. Additional intraoperative fentanyl requirement was significantly lower in Group M compared to Group A (50.20 ± 13.65 µg vs 75.80 ± 17.40 µg, p <0.0001). Time to first additional fentanyl was longer in Group M (36.85 ± 8.40 min vs 23.10 ± 6.25 min, p <0.0001). Adverse effects were comparable between both groups. Conclusion: Mandibular nerve block provided better intraoperative and early postoperative analgesic profile than inferior alveolar nerve block in unilateral mandibular fracture surgery under general anaesthesia.

Keywords: Mandibular fracture, inferior alveolar nerve block, mandibular nerve block, bupivacaine, postoperative analgesia, fentanyl.