Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients
Identifieur interne : 000F81 ( Pmc/Checkpoint ); précédent : 000F80; suivant : 000F82Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients
Auteurs : Ferdinand Frederik Som Ling Tan [Pays-Bas] ; Sjouke Schiere [Pays-Bas] ; Auke C. Reidinga [Pays-Bas] ; Fennie Wit [Pays-Bas] ; Peter Hjm Veldman [Pays-Bas]Source :
- Local and Regional Anesthesia [ 1178-7112 ] ; 2015.
Abstract
Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block.
Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion.
Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day.
A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.
Url:
DOI: 10.2147/LRA.S63246
PubMed: 25999760
PubMed Central: 4437613
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Reidinga</name><affiliation wicri:level="1"><nlm:aff id="af2-lra-8-011">Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author><author><name sortKey="Wit, Fennie" sort="Wit, Fennie" uniqKey="Wit F" first="Fennie" last="Wit">Fennie Wit</name><affiliation wicri:level="1"><nlm:aff id="af3-lra-8-011">Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Surgery, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author><author><name sortKey="Veldman, Peter Hjm" sort="Veldman, Peter Hjm" uniqKey="Veldman P" first="Peter Hjm" last="Veldman">Peter Hjm Veldman</name><affiliation wicri:level="1"><nlm:aff id="af3-lra-8-011">Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Surgery, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25999760</idno><idno type="pmc">4437613</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437613</idno><idno type="RBID">PMC:4437613</idno><idno type="doi">10.2147/LRA.S63246</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000197</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000197</idno><idno type="wicri:Area/Pmc/Curation">000197</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000197</idno><idno type="wicri:Area/Pmc/Checkpoint">000F81</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000F81</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients</title><author><name sortKey="Tan, Ferdinand Frederik Som Ling" sort="Tan, Ferdinand Frederik Som Ling" uniqKey="Tan F" first="Ferdinand Frederik Som Ling" last="Tan">Ferdinand Frederik Som Ling Tan</name><affiliation wicri:level="3"><nlm:aff id="af1-lra-8-011">Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Anesthesiology, University Medical Center Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Schiere, Sjouke" sort="Schiere, Sjouke" uniqKey="Schiere S" first="Sjouke" last="Schiere">Sjouke Schiere</name><affiliation wicri:level="3"><nlm:aff id="af1-lra-8-011">Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Anesthesiology, University Medical Center Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Reidinga, Auke C" sort="Reidinga, Auke C" uniqKey="Reidinga A" first="Auke C" last="Reidinga">Auke C. Reidinga</name><affiliation wicri:level="1"><nlm:aff id="af2-lra-8-011">Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author><author><name sortKey="Wit, Fennie" sort="Wit, Fennie" uniqKey="Wit F" first="Fennie" last="Wit">Fennie Wit</name><affiliation wicri:level="1"><nlm:aff id="af3-lra-8-011">Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Surgery, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author><author><name sortKey="Veldman, Peter Hjm" sort="Veldman, Peter Hjm" uniqKey="Veldman P" first="Peter Hjm" last="Veldman">Peter Hjm Veldman</name><affiliation wicri:level="1"><nlm:aff id="af3-lra-8-011">Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Surgery, de Tjongerschans Hospital, Heerenveen</wicri:regionArea><wicri:noRegion>Heerenveen</wicri:noRegion></affiliation></author></analytic><series><title level="j">Local and Regional Anesthesia</title><idno type="eISSN">1178-7112</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block.</p></sec><sec><title>Patients and methods</title><p>Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion.</p></sec><sec><title>Results</title><p>Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day.</p></sec><sec><title>Conclusion</title><p>A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cousins, Mj" uniqKey="Cousins M">MJ Cousins</name></author><author><name sortKey="Bridenbaugh, Po" uniqKey="Bridenbaugh P">PO Bridenbaugh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kehlet, H" uniqKey="Kehlet H">H Kehlet</name></author><author><name sortKey="Dahl, Jb" uniqKey="Dahl J">JB Dahl</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kehlet, H" uniqKey="Kehlet H">H Kehlet</name></author><author><name sortKey="Wilmore, Dw" uniqKey="Wilmore D">DW Wilmore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodgers, A" uniqKey="Rodgers A">A Rodgers</name></author><author><name sortKey="Walker, N" uniqKey="Walker N">N Walker</name></author><author><name sortKey="Schug, S" uniqKey="Schug S">S Schug</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hargett, Mj" uniqKey="Hargett M">MJ Hargett</name></author><author><name sortKey="Beckman, Jd" uniqKey="Beckman J">JD Beckman</name></author><author><name sortKey="Liguori, Ga" uniqKey="Liguori G">GA Liguori</name></author><author><name sortKey="Neal, Jm" uniqKey="Neal J">JM Neal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fleisher, La" uniqKey="Fleisher L">LA Fleisher</name></author><author><name sortKey="Beckman, Ja" uniqKey="Beckman J">JA Beckman</name></author><author><name sortKey="Brown, Ka" uniqKey="Brown K">KA Brown</name></author><author><name sortKey="Smith, Sc" uniqKey="Smith S">SC Smith</name></author><author><name sortKey="Jacobs, Ak" uniqKey="Jacobs A">AK Jacobs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, Hg" uniqKey="Park H">HG Park</name></author><author><name sortKey="Park, Pg" uniqKey="Park P">PG Park</name></author><author><name sortKey="Kim, Wj" uniqKey="Kim W">WJ Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Syverud, Sa" uniqKey="Syverud S">SA Syverud</name></author><author><name sortKey="Jenkins, Jm" uniqKey="Jenkins J">JM Jenkins</name></author><author><name sortKey="Schwab, Ra" uniqKey="Schwab R">RA Schwab</name></author><author><name sortKey="Lynch, Mt" uniqKey="Lynch M">MT Lynch</name></author><author><name sortKey="Knoop, K" uniqKey="Knoop K">K Knoop</name></author><author><name sortKey="Trott, A" uniqKey="Trott A">A Trott</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Local Reg Anesth</journal-id><journal-id journal-id-type="iso-abbrev">Local Reg Anesth</journal-id><journal-id journal-id-type="publisher-id">Local and Regional Anesthesia</journal-id><journal-title-group><journal-title>Local and Regional Anesthesia</journal-title></journal-title-group><issn pub-type="epub">1178-7112</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25999760</article-id><article-id pub-id-type="pmc">4437613</article-id><article-id pub-id-type="doi">10.2147/LRA.S63246</article-id><article-id pub-id-type="publisher-id">lra-8-011</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Series</subject></subj-group></article-categories><title-group><article-title>Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tan</surname><given-names>Ferdinand Frederik Som Ling</given-names></name><xref ref-type="aff" rid="af1-lra-8-011">1</xref><xref ref-type="corresp" rid="c1-lra-8-011"></xref></contrib><contrib contrib-type="author"><name><surname>Schiere</surname><given-names>Sjouke</given-names></name><xref ref-type="aff" rid="af1-lra-8-011">1</xref></contrib><contrib contrib-type="author"><name><surname>Reidinga</surname><given-names>Auke C</given-names></name><xref ref-type="aff" rid="af2-lra-8-011">2</xref></contrib><contrib contrib-type="author"><name><surname>Wit</surname><given-names>Fennie</given-names></name><xref ref-type="aff" rid="af3-lra-8-011">3</xref></contrib><contrib contrib-type="author"><name><surname>Veldman</surname><given-names>Peter HJM</given-names></name><xref ref-type="aff" rid="af3-lra-8-011">3</xref></contrib></contrib-group><aff id="af1-lra-8-011"><label>1</label>Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands</aff><aff id="af2-lra-8-011"><label>2</label>Department of Anesthesiology, de Tjongerschans Hospital, Heerenveen, the Netherlands</aff><aff id="af3-lra-8-011"><label>3</label>Department of Surgery, de Tjongerschans Hospital, Heerenveen, the Netherlands</aff><author-notes><corresp id="c1-lra-8-011">Correspondence: Ferdinand Frederik Som Ling Tan, Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands, Tel +31 50 361 6161, Email <email>f.f.s.l.tan@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>14</day><month>5</month><year>2015</year></pub-date><volume>8</volume><fpage>11</fpage><lpage>14</lpage><permissions><copyright-statement>© 2015 Tan et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement><copyright-year>2015</copyright-year><license><license-p>The full terms of the License are available at <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block.</p></sec><sec><title>Patients and methods</title><p>Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion.</p></sec><sec><title>Results</title><p>Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day.</p></sec><sec><title>Conclusion</title><p>A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>intraoral</kwd><kwd>regional anesthesia</kwd><kwd>percutaneous</kwd><kwd>ultrasound</kwd><kwd>mental nerve block</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-lra-8-011" position="float"><label>Figure 1</label><caption><p>Anatomy and innervation of the mental nerve.</p><p><bold>Notes:</bold> The mental nerve is a branch of the mandibular branch of the trigeminal nerve and exits the mental foramen (<bold>A</bold>). The innervation is indicated by the yellow area on the lower lip and chin (<bold>B</bold>).</p></caption><graphic xlink:href="lra-8-011Fig1"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Pays-Bas</li></country><region><li>Groningue (province)</li></region><settlement><li>Groningue</li></settlement></list><tree><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Tan, Ferdinand Frederik Som Ling" sort="Tan, Ferdinand Frederik Som Ling" uniqKey="Tan F" first="Ferdinand Frederik Som Ling" last="Tan">Ferdinand Frederik Som Ling Tan</name></region><name sortKey="Reidinga, Auke C" sort="Reidinga, Auke C" uniqKey="Reidinga A" first="Auke C" last="Reidinga">Auke C. Reidinga</name><name sortKey="Schiere, Sjouke" sort="Schiere, Sjouke" uniqKey="Schiere S" first="Sjouke" last="Schiere">Sjouke Schiere</name><name sortKey="Veldman, Peter Hjm" sort="Veldman, Peter Hjm" uniqKey="Veldman P" first="Peter Hjm" last="Veldman">Peter Hjm Veldman</name><name sortKey="Wit, Fennie" sort="Wit, Fennie" uniqKey="Wit F" first="Fennie" last="Wit">Fennie Wit</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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