Mp06-10 Effect of Inferior Alveolar Plus Buccal Nerve Block on Postoperative Morbidity at Buccal Mucosal Graft Harvest Site: A Prospective Double-Blind Randomised Controlled Trial

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-10 EFFECT OF INFERIOR ALVEOLAR PLUS BUCCAL NERVE BLOCK ON POSTOPERATIVE MORBIDITY AT BUCCAL MUCOSAL GRAFT HARVEST SITE: A PROSPECTIVE DOUBLE-BLIND RANDOMISED CONTROLLED TRIAL Swarnendu Mandal, Prasant Nayak, Manoj Kumar Das, Sambit Tripathy, Prasanna Ram, and Vivek Tarigopula Swarnendu MandalSwarnendu Mandal , Prasant NayakPrasant Nayak , Manoj Kumar DasManoj Kumar Das , Sambit TripathySambit Tripathy , Prasanna RamPrasanna Ram , and Vivek TarigopulaVivek Tarigopula View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative pain at the Buccal Mucosal Graft (BMG) harvest site often hinders the resumption of oral diet. Various strategies to hasten oral rehabilitation have been tried without any notable success. The combined Inferior Alveolar plus Buccal Nerve Block (IANB+BNB) covers the area of interest, and we aim to study if this strategy impacts postoperative pain, analgesic requirement and patient recovery. METHODS: This was an ethics committee approved (T/IM-NF/Uro/22/35), Clinical-Trials-Registry-India (CTRI) registered (CTRI/2022/08/044889) double-blind Randomised Controlled Trial (RCT) conducted in the department of urology at a single tertiary care centre in India between September 2022 and April 2023. The intervention arm received IANB+BNB using a mixture of 5 ml 1% lignocaine, 5 ml 0.25% bupivacaine, and 4 mg dexamethasone, while the control arm received 10 ml of normal saline. In both arms, a combination of 2% lignocaine and (1:100,000) epinephrine was infiltrated at the bed prior to BMG harvest. The surgeon and patients were blinded. Postoperative pain scores at the harvest site were recorded using the Visual-Analog-Scale (VAS). Postoperative analgesic and opioid requirements and time for resumption of pain-free liquid and solid diets were compared RESULTS: The study recruited 56 patients, as per the sample size calculation, who were randomised 1:1. The mean age [43.89(±15.69) vs 41.89(±9.76) years; p=0.850], mean graft area [5.98(±4.25) vs 5.63(±3.4) cm2; p=0.722] were comparable between the study groups. Patients who received IANB+BNB had significantly lesser pain at zero hours [4(2-10) vs 0(0-2); p=0.001], two hours [4(2-10) vs 2(0-4); p=<0.001], six hours [4(2-8) vs 2(0-6); p=<0.001], 12 hours [4(2-8) vs 2(0-6); p=0.010], 24 hours [4(2-7) vs 2(0-7); p=0.001], 48 hours [4(0-8) vs 2(0-7); p=0.007], 72 hours [2(1-6) vs 2(0-8); p=0.006] and Post Operative Day (POD)-five [2(2-6) vs 1(0-4); p=0.025]. The pain was comparable beyond POD-seven. The cumulative paracetamol requirement was lower in the intervention arm [6(4-15) vs 9(4-20) g; p=<0.001]. Fewer patients receiving IANB+BNB required opioids for breakthrough analgesia [4 vs 15; p=0.002], and the cumulative milligram morphine equivalents (MME) was also less [0(0-110) vs 15(0-140); p=0.002]. Patients in the intervention arm resumed pain-free liquids [1(1-2) vs 2(1-2) days; p=<0.001] and solids [2(1-5) vs 3(1-5) days; p=0.001) quicker by one day CONCLUSIONS: This first-of-its-kind study showed that patients who received IANB+BNB had lesser postoperative pain scores, analgesic requirement and quicker resumption of normal diets. Applying this easily reproducible strategy can enhance oral rehabilitation in patients undergoing BMG harvest across various reconstructive urological procedures. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e55 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Swarnendu Mandal More articles by this author Prasant Nayak More articles by this author Manoj Kumar Das More articles by this author Sambit Tripathy More articles by this author Prasanna Ram More articles by this author Vivek Tarigopula More articles by this author Expand All Advertisement PDF downloadLoading ...