UNASSIGNED: Cleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery.
METHODS: This case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively.
CONCLUSIONS: The combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively.
CONCLUSIONS: Infraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

UNASSIGNED: The location of infraorbital foramen (IOF) and the prevalence of accessory IOF vary among different populations. It may lead to infraorbital nerve (ION) blockage during surgery. This study aimed to assess the IOF location and AIOF frequency in Iranian people.
METHODS: In this retrospective cross-sectional study, 500 paranasal sinus computed tomography scans of adults were examined using the INFINITT PACS system.
RESULTS: The distance from IOF to infraorbital margin (IOM), mid-pupillary line (MPL), midsagittal line (MSL), canine eminence (CE), and skin thickness (ST) was 8.97 ± 1.79, 5.73 ± 1.84, 24.86 ± 2.23, 20.39 ± 3.47, and 10.90 ± 2.59 mm, respectively. The vertical and transverse diameters of the foramen were 3.03 ± 0.65 and 3.71 ± 0.76 mm, respectively. In addition, the shape of 63.5% of the foramina was oval. The prevalence of AIOF was 9%, and its most common location was superomedial to IOF.
CONCLUSIONS: We believe that in this study, landmarks like IOM, MPL, MSL, CE and ST could help the clinicians localize IOF and improve the ION anesthesia success rate. Furthermore, the occurrence of AIOF should be considered by physicians to reduce the chance of injuries to the infraorbital neurovascular complex.

BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates.
METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block.
RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia.
CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates.
RESULTS:
UNASSIGNED: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.

Ipsilateral hemi facial spasm, trigeminal autonomic orofacial pain and occipital neuralgia may occur due to close proximity of V and VII nerves in pons and inter-neuronal interconnections of trigeminocervical complex. In this report, we describe management of a patient with long standing untreated left hemi facial spasm of ten years with contralateral trigeminal autonomic orofacial pain and occipital neuralgia present for last five years. Repeated intramuscular injections of Botulinum neurotoxin A were given for hemi facial spasm which completely resolved the twitches for 5-8 months with decreased baseline twitches noted before next cycle of injections. Addition of Botulinum neurotoxin A in nerve block injections for occipital neuralgia resulted in prolonged relief of five months and decreased baseline pain scores. Addition of Botulinum neurotoxin A to nerve block injections for trigeminal autonomic orofacial pain decreased autonomic features and baseline pain scores.

UNASSIGNED: In this study, we evaluated the hypothesis that preoperative bilateral infraoptic nerve (ION) and infratrochlear nerve (ITN) blocks under general anesthesia with sevoflurane and remifentanil reduced the incidence of emergence agitation (EA), pain scores, and the analgesic consumption after the septorhinoplasty.
UNASSIGNED: Our study was conducted as a prospective randomized, double-sided blind study. Fifty-two patients whose septorhinoplasty operation was planned under general anesthesia were included in the study. Patients were randomly distributed to either the ION and ITN blocks were performed. Group 1: Bilateral ION and ITN blocks were performed; Group 2: ION and ITN blocks were not performed. Duration of the surgery and anesthesia, Riker Sedation-Agitation Scale (RSAS) score, EA presence, duration of postoperative analgesia, numerical rating scale (NRS) scores, and cumulative dexketoprofen consumption were recorded.
UNASSIGNED: The RSAS score, NRS score and cumulative dexketoprofen consumption of the patients in Group 1 were statistically significantly lower than the patients in Group 2 (p<0.05). It was also found that patients in Group 1 (n: 8/26) had less EA compared to patients in Group 2 (n: 16/26) and this difference was statistically significant (p: 0.026). Postoperative analgesia duration of patients in Group 1 was found to be statistically significantly higher than patients in Group 2 (p: <0.001). In addition, the number of patients given postoperative dexketoprofen in Group 1 (n: 8/26) was found to be statistically significantly lower than patients in Group 2 (n: 25/26). (p: <0.001).
UNASSIGNED: Bilateral ION and ITN blocks in septorhinoplasty operation is an effective, reliable and simple technique in the treatment of postoperative pain.

Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies.

UNASSIGNED: To compare dexamethasone (DA) to dexmedetomidine (DE) as adjuvants for bupivacaine during infraorbital nerve block (IONB) in a randomized clinical trial.
UNASSIGNED: One hundred patients were randomized into two equal groups. By the guidance of ultrasound, the IONB was performed bilaterally in all patients, using 1 mL of the solution on each side. In DA group, 1 mL of 0.5% bupivacaine was added to 0.1 mg.kg-1 DA and diluted to 2 mL in DE group; 1 mL of 0.5% bupivacaine was added to 0.5 μg.kg-1 DE and diluted to 2 mL. The primary outcome was time to first rescue analgesic. The secondary outcomes included face legs activity cry consolability (FLACC) score rating during the first 24 h, hemodynamic variables, the incidence of postoperative vomiting, sedation score, and parent satisfaction.
UNASSIGNED: During the first 24 h postoperatively, the DE group showed a significantly lower FLACC score and a longer time to first analgesic request compared to DA group. Sedation and parent satisfaction scores were significantly higher while heart rate and mean blood pressure were significantly lower in DE group compared to DA group. There were no differences in other secondary outcomes.
UNASSIGNED: The use of DE as an adjuvant to bupivacaine in IONB for cleft lip repair resulted in lower pain score and more prolonged duration of analgesia compared to DA.

OBJECTIVE: The aims were to use different techniques to assess the degree of sensory changes and magnitude of perceived size changes in the facial region induced by nerve blocks of two different trigeminal nerve branches in healthy participants.
METHODS: This placebo-controlled study included 30 healthy volunteers. The participants underwent quantitative and qualitative sensory testing (QST and QualST) thrice: before, 10 min, and 2 h after mental (n = 15) and infraorbital (n = 15) nerve blocks and during control (saline) sessions. Perceived numbness, temperature changes, and perceptual distortion were also measured at all time points during the nerve block and control sessions. Differences in outcome parameters between the sessions and time points were analyzed using analyses of variance and McNemar\'s tests.
RESULTS: There was a significant degree of sensory loss to most QST and all QualST parameters, with significant numbness and increased perceived size at the injection site 10 min and 2 h after the nerve blocks compared with saline (P < 0.030) and the baseline (P < 0.042). Two hours after the nerve blocks, the sensitivity was significantly closer to baseline than after 10 min to most of the QST parameters (P < 0.011).
CONCLUSIONS: QST and QualST revealed that the nerve blocks in the orofacial region resulted in complete or partial blockade of afferent nerve fibers mediating thermal and mechanical function for more than 2 h with significant numbness and perceptual distortion.
CONCLUSIONS: Both QST and QualST can provide information on the degree of blockade of afferent nerve fibers after nerve blocks in the orofacial region.

Background Trigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face. Drug therapy is the first choice of treatment. However, in cases where drug therapy are contraindicated due to side effects, patients can get pain relief from lengthy neurosurgical procedures. Alternatively, a peripheral trigeminal nerve block can be easily performed in an outpatient setting. Therefore it is a useful treatment option for the acute paroxysmal period of TN in patients who cannot use drug therapy. We performed real-time ultrasound guidance for infraorbital nerve blocks in TN patients using a high concentration of tetracaine dissolved in bupivacaine. In this report, we examine the efficacy of our methods. Patients As approved by the Institutional Review Board, the medical records in our hospital were queried retrospectively. Six patients with TN at the V2 area matched the study criteria. All patients could not continue drug therapy with carbamazepine due to side effects and they received an ultrasound-guided infraorbital nerve block with a high concentration of tetracaine dissolved in bupivacaine. Methods The patient was placed in the supine position and the patient\'s face was sterilized and draped. An ultrasound system with a 6-13 MHz linear probe was used with a sterile cover. The probe was inserted into the horizontal plane of the cheek just beside the nose and was slid in the cranial direction to find the dimple of the infraorbital foramen. The 25G 25 mm needle was inserted from the caudal side just across from the probe using an out-of-plane approach. To lead the needle tip to the foramen, needle direction was corrected with real-time ultrasound guidance. After the test block with lidocaine (2%, 0.5 ml), a solution of tetracaine (20 mg) dissolved in bupivacaine (0.5%, 0.5 ml) was injected. During each injection, the spread of the agent around the nerve was confirmed using ultrasound images. Results Ten blocks were performed for six patients. Immediately after the procedure, all 10 blocks produced analgesia and relieved the pain. In the three blocks, pain was experienced in a new trigger point outside of the infraorbital nerve region (around the back teeth) within a week after the block and pain were relieved using other treatment. Two patients developed small hematomas in the cheek but they disappeared in a week. All patients did not complain about other side effects including paraesthesia, hyperpathia, dysaesthesia, or double vision. Hypoaesthesia to touch and pain in the infraorbital region were observed in all blocks after 2 weeks. Conclusions We performed real-time ultrasound-guided infraorbital nerve block for TN with a high concentration of tetracaine dissolved in bupivacaine. Our method achieved a high success rate and there were only minor and transient side effects. Implications Real-time ultrasound-guided infraorbital nerve block is one of the useful options to treat the acute paroxysmal period of TN at the infraorbital nerve area. Ultrasound-guided injections may become the standard practice for injecting peripheral trigeminal nerves. Using this high concentration of tetracaine as a neurolytic agent is effective and appears to have only minor side effects.

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