Evaluation of Superficial Cervical Plexus Block for Incision and Drainage of Facial Space Infections: A Prospective Clinical Study Misra Gyanendra1,*, Prasad Kavitha2, Lalitha R.M.3, Krishnappa Ranganath4, Rajanikanth B.R.5, Sejal K.M.5, Sagar Parimala5, Kumar Vineeth5, Gopalraju Prathibha5 1Ex Post Graduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru-560054 2Professor and Head, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru-560054 3Ex Senior Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru-560054 4Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru-560054 5Associate Professor, Assitant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru-560054 *Corresponding Author E-Mail: iamkps11@gmail.com
Online published on 24 January, 2020. Abstract Background Odontogenic infections are the most common source for spreading facial space infections. The infections of these potential spaces in the facial planes include acute cellulitis of the soft tissue with or without true abscess formation. Aggressive incision and drainage (I&D) of all the involved spaces is considered necessary to assure fast resolution of the infection and to eventually maintain a patent airway. An adequate level of anesthesia has been a critical component of the treatment plan. Skin in front of, above, below the ear and anterior aspect of neck is supplied by cervical plexus. A superficial cervical plexus block is an option worth considering in these cases. The injection site is usually far enough away from the intended area for I&D to be performed safely. Material and Methods The study protocol involved incision and drainage of facial space infection involving submandibular, submental, sublingual and/or pharyngeal spaces, performed under MAC and superficial cervical plexus block with concomitant inferior alveolar nerve block. Clinical parameters evaluated were intraoperative pain (During incision, drainage, drain fixation and immediately after the procedure in recovery room), amount of sedation required during the procedure and complications if any. Results During incision 80% patients scored the pain on VAS to be 2, and rest two patients gave a score of 3 and four. During exploration and drainage of the involved spaces the average pain score was 4.4 where 60% patients scored it below 4, 30% scored it to be 5 and one patient had extreme pain and scored it to be 9. The pain scores during drain fixation was 2 or less in 90% cases and 3 in remaining 30%. Immediately after the incision and drainage all the patients had a significant pain relief in the recovery room and scored the pain to be 4 or less on VAS scale. 9 of 10 patients did not have any complications during the procedure. One patient had seizure and cardiac arrest during exploration of the space, emergency tracheostomy was done and I&D was completed successfully. Conclusion Bilateral SCPB with inferior alveolar nerve block provides significant intraoperative pain control for drainage of submandibular, submental, sublingual and or pharyngeal space infections. It offers an effective alternate to general anesthesia which is easy to learn, has low complication rate and a high success rate, thereby reducing the total length of hospital stay and overall cost of the treatment. Top Keywords Odontogenic Infection, Facial Space Infection, Superficial Cervical Plexus Block. Top |