ESRA19-0260 Clinical experiences with ultrasound-guided suprazygomatic maxillary nerve block in zygomatic implants surgery: a new indication

Background and aims Zygomatic implant surgery (ZIS) is indicated for the rehabilitation of the severe atrophic maxilla. Anesthetic management of these patients is a challenge. For pain control, a multimodal approach is recommended, and loco-regional-anesthesia techniques (LRAT) are an essential pillar. Researchers propose bilateral blockade of the maxillary nerve (BBMN) by ultrasound-guided suprazigomatic-route for ZIS for better pain control. Methods In this clinical trial, after ethical committee approval, patients were randomly assigned to 2 groups to receive (study group) or not receive (control group) BBMN (4 ml Ropivacaine0.5%) together with local infiltration with Lidocaine (10 ml Lidocaine2%) and general anesthesia. the main objective was the consumption of opioids. Pain, postoperative nausea-vomiting (PONV) and complications derived from BBMN were also recorded. Results The researchers present the preliminary results of 9 patients. Patients who received BBMN presented better results in terms of: lower intraoperative opioids consumption (p=0.016), lower rate of patients who demanded methadone (100% control vs 20% study, p=0.048) and lower dose of methadone administered (3 mg control vs 0 mg study, p=0.016) at 2 hours postoperatively, lower level of pain at any time of the first 8 hours postoperatively (p=0.016), and lower incidence of PONV (75% control vs 0% study, p=0.048). No complications derived from the BBMN were reported. Conclusions The results obtained suggest that the BBMN is a promising LRAT to decrease opioid consumption and greater patient comfort for ZIS. the small size of the sample prevents generalization and may involve risks of overinterpretation and publication bias. Larger studies need to be conducted to corroborate the efficacy of this new indication.