title: Infraorbital and infratrochlear nerve blocks combined with general anaesthesia for outpatient rhinoseptoplasty: A prospective randomised, double-blind, placebo-controlled study.
abstract: BACKGROUND
  We conducted a study to determine the efficacy of bilateral extraoral infraorbital and infratrochlear nerve blocks during outpatient rhinoseptoplasty under general anaesthesia.
  
  
  METHODS
  In this prospective, double-blind, randomised, controlled trial, 40 adult patients undergoing outpatient rhinoseptoplasty under general anaesthesia were assigned to receive bilateral infraorbital and infratrochlear nerve blocks with either 10mL of 0.25% levobupivacaine (Group LB) or isotonic saline (control group). Patients in Group LB received 0.1mL/kg of isotonic saline as a placebo and patients in the control group received 0.1mL/kg of morphine. The primary endpoint was total perioperative morphine consumption (intraoperative and in the post-anaesthesia care unit). The secondary endpoints were pain scores, time spent in the post-anaesthesia care unit and the outpatient ward, block-related complications and patient satisfaction.
  
  
  RESULTS
  The total dose of perioperative morphine was lower in Group LB than in the control group (2.5±2.8mg versus 9.5±3.5mg, respectively, P<0.001). The mean±SD or median [IQR] times spent in the post-anaesthesia care unit (60±10min and 78±33min, respectively, P<0.03) and in the outpatient ward (210 [178-223] min versus 275 [250-300] min, respectively, P<0.001) were lower in Group LB than in the control group. There were no differences between groups for other endpoints.
  
  
  CONCLUSIONS
  Bilateral extraoral infraorbital and infratrochlear nerve blocks performed with 0.25% levobupivacaine during general anaesthesia combining remifentanil and desflurane reduce the perioperative dose of morphine and the time spent in the post-anaesthesia care unit and the outpatient ward in adult patients undergoing outpatient rhinoseptoplasty.
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France; Claude-Bernard Lyon I university, university of Lyon, Lyon, France. Electronic address: emmanuel.boselli@chu-lyon.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boselli
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Bouvet
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Augris-Mathieu
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Bégou
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Diot-Junique
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Najia
authors.initials: N
authors.lastname: Rahali
authors.affiliation: Department of otolaryngology-head and neck surgery, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vertu-Ciolino
authors.affiliation: Department of pharmacy, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gérard
authors.affiliation: Department of pharmacy, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Pivot
authors.affiliation: Claude-Bernard Lyon I university, university of Lyon, Lyon, France; Department of otolaryngology-head and neck surgery, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Disant
authors.affiliation: Department of anaesthesiology and intensive care, Édouard-Herriot hospital, Hospices Civils de Lyon, Lyon, France; Claude-Bernard Lyon I university, university of Lyon, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General / Q000379:methods*; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009300:Nasal Septum / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D009915:Orbit; D010045:Outpatients; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*; D014321:Trochlear Nerve
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: Facial nerve block; Infraorbital; Infratrochlear; Levobupivacaine; Outpatient; Rhinoplasty