title: [Percutaneous mandibular nerve block using neuro-stimulation guiding through the sigmoid indentation in facial surgery].
abstract: BACKGROUND
  Mandibular nerve block is a simple and effective but rarely used technique. It decreases peri-operative pain in mandibular osteotomy. It improves surgical field visibility by decreasing bleeding. Mandibular nerve block allows cutaneous surgery without general anesthesia and is one of the alternative treatments for chronic facial pain.
  
  
  METHODS
  The mandibular nerve is located using a needle connected to a neurostimulator. After local disinfection, a neurostimulation needle is inserted below the zygomatic arch, between the coronoid apophysis in front, and the condyle process in back, with a 45 to 60° angle. The needle is pushed to a 40 mm depth. Masticator muscle contraction confirms mandibular nerve stimulation. After a careful negative aspiration, 5 mL of ropivacaine 0.5% are injected slowly, and in increments.
  
  
  CONCLUSIONS
  The complications with this technique, such as failure or arterial puncture, are rare and limited if a nerve stimulator is used. Patient's comfort is improved by intravenous remifentanil sedation in target control infusion mode, associated to prior use of prilocaine and lidocaine cutaneous cream.
authors.affiliation: Service d'Anesthésie-Réanimation II, Université François-Rabelais, hôpital Trousseau, CHU de Tours, 37044 Tours cedex 09, France. fabien.espitalier@univ-tours.fr
authors.forename: F
authors.initials: F
authors.lastname: Espitalier
authors.forename: A-F
authors.initials: AF
authors.lastname: Dubost
authors.forename: D
authors.initials: D
authors.lastname: Goga
authors.forename: B
authors.initials: B
authors.lastname: Laure
authors.forename: J
authors.initials: J
authors.lastname: Fusciardi
mesh_terms: D000279:Administration, Cutaneous; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002610:Cheek; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008340:Mandibular Nerve / Q000187:drug effects* / Q000473:pathology / Q000502:physiology; D008954:Models, Biological; D009339:Needles; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010812:Physical Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011318:Prilocaine / Q000008:administration & dosage; D000077212:Ropivacaine; D013515:Surgery, Oral / Q000379:methods*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D011318:Prilocaine; D000077212:Ropivacaine; D008012:Lidocaine