Is Inferior Alveolar Nerve Block Beneficial in Fracture Mandibular Surgeries? A Randomized Controlled Trial

Background: The immediate postoperative phase following surgery for the fixation of a mandibular fracture can be extremely painful. Intravenous opioids are commonly used to treat these patients, but they can cause respiratory depression, pruritus, nausea, and vomiting. For mandibular and intraoral operations, peripheral nerve blocks offer effective perioperative analgesia and can be utilized in conjunction with multimodal analgesia to reduce opioid use during the recovery phase. Objectives: This study aims to evaluate the effectiveness of incorporating a pre-emptive inferior alveolar nerve block (IANB) compared to traditional systemic intravenous analgesia for managing perioperative pain in mandibular fracture surgeries. Methods: This prospective, randomized, double-blind comparative study enrolled 46 adult patients scheduled for mandibular fracture surgeries. Participants were randomly assigned to two equal groups. Patients in group A (IANB group) underwent bilateral IANB following endotracheal intubation and before surgical positioning and incision. Group B, serving as a control, received intravenous multimodal analgesia as usual but did not undergo block administration. The primary objective was to assess the intensity and duration of the analgesic effect of the IANB by measuring the time to the first dose and total doses of fentanyl rescue analgesia guided by hemodynamic changes intraoperatively, and the time to the first dose and total doses of pethidine as rescue analgesia postoperatively, guided by the Visual Analog Scale (VAS) in both groups. In group A, any block-related complications were considered a secondary outcome. Results: There was no statistically significant difference in the periods of fentanyl required across the groups tested. However, the IANB group had a much lower intraoperative fentanyl dose (P < 0.001), resulting in a significantly reduced need for intraoperative fentanyl. The IANB group showed the best response regarding pain control postoperatively for 6 hours; thereafter, no statistically significant difference was observed between the two groups. Concerning the total dosage of pethidine administered in each group, the IANB group used significantly less pethidine than the control group (P < 0.001). Conclusions: Bilateral IANB can be an effective and safe method for reducing opioid consumption and controlling perioperative pain and discomfort in mandibular fracture surgeries.