Analgesic efficacy of inferior alveolar nerve block for mandibular fracture surgeries: A prospective case series

• Author Details:   
• Pinal Raj Bumiya
• Zeal Pranavkumar Patwari ^*
• Divya Gajra
• Kavita Lalchandani
• Kumud Ganvit
• Devyani Jatin Desai

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Background: Mandibular fractures are the most common facial bone injuries following road traffic accidents. Open reduction and internal fixation (ORIF) of these fractures is associated with significant perioperative pain, which traditionally necessitates high doses of opioids and NSAIDs, leading to adverse effects and complicating airway management due to trismus. Combining regional anaesthesia with general anaesthesia offers a promising multimodal approach. The inferior alveolar nerve block (IANB), particularly the Conventional Halstead technique, effectively anesthetizes the mandible. While commonly used in dentistry, its application for perioperative analgesia in mandibular trauma surgery is underexplored. This case series evaluates the analgesic efficacy of IANB in patients undergoing ORIF for mandibular fractures.

Methods: This prospective case series included five ASA I-II patients (aged 19-37) with mandibular fractures and limited mouth opening (inter-incisor distance [IID] ≤20 mm). Preoperatively, all patients received an IANB using the Halstead technique with 2 mL of 0.25% bupivacaine. Mouth opening (IID) and pain scores (Visual Analogue Scale, VAS) were assessed before and 10 minutes after the block. The primary outcome was the duration of postoperative analgesia; secondary outcomes included improvement in IID, intraoperative hemodynamic stability, and 24-hour opioid consumption.

Results: The IANB significantly improved mouth opening, with a median IID increase of 9 mm (35-81% improvement), facilitating conventional laryngoscopy. Post-block VAS scores decreased markedly (median pre-block: 6; post-block: 2). Intraoperative hemodynamics were stable, and no additional intraoperative opioids were required. The median duration of postoperative analgesia was 16 hours, with patients requiring only a single rescue analgesic (IV paracetamol) within the first 24 hours.

Conclusion: The preoperative Inferior Alveolar Nerve Block is a highly effective component of a multimodal analgesic strategy for mandibular ORIF. It significantly improves mouth opening, facilitates airway management, provides profound intraoperative and prolonged postoperative analgesia, minimizes opioid requirements, and promotes hemodynamic stability.