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Background: Myofascial pain syndrome MPS is one of the most common causes of chronic musculoskeletal pain. It clinically presents with hypersensitive points in the muscle called "trigger points". Most of the time it remains undiagnosed/undertreated and this leads to severity in symptoms. Deactivation/elimination of trigger points (TrPs) remains the cornerstone of myofascial pain dysfunction syndrome (MPDS) management. The most commonly employed techniques clinically are dry needling of the TrP, local anesthetics or saline injections into TrP, spray and stretch, and ultrasound/electrogalvanic stimulation. Although peripheral nerve blocks are widely used for chronic pain management, their role in myofascial pain dysfunction syndrome is not yet well established. Our study aims to demonstrate the role of mandibular nerve block using lignocaine hydrochloride in the management of MPDS. Materials and Method: Our study is a single-centered randomized control trial performed to evaluate the diagnostic and therapeutic role of mandibular nerve block in treating myofascial pain dysfunction syndrome. A total of 20 subjects fulfilling the inclusion criteria were enrolled in the study. Clinical parameters (pain, mouth opening, and mandibular deviation) were assessed at each follow-up appointment. Result: All of our patients had significant pain relief at the end of 1 month (P < 0.001), and a substantial improvement in mouth opening is also noted (P < 0.001). There was a significant improvement in deviation immediately after nerve block, and further gradual improvement was observed during each follow-up. Conclusion: Our study confirmed the role of mandibular nerve block in myofascial pain management. The diagnostic value of mandibular nerve block in differentiating MPDS from internal derangement is also highlighted. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a modified maxillo-mandibular nerve block technique that includes anesthetizing the maxillary and mandibular nerve with single injection. Materials and Methods: A prospective, clinical cohort study was carried out including patients who presented for surgical removal of maxillary and mandibular third molars. All patients were administered maxilla-mandibular nerve block through a single injection on one side. Three clinical neurosensory tests were used for mapping the area of anesthesia and to assess and grade objectively the effect of the block. Light touch (LT), two-point discrimination (TPD), pin prick (PP) and Electric pulp testing (EPT) were used for all branches of maxillary and mandibular nerve. An extra oral mapping chart for depth of anesthesia was maintained for each patient to categorize the grades as nil, intermediate and highly anesthetized areas. Results: 62 patients were assessed in the study. EPT showed greater depth of pulpal anesthesia in posterior teeth than the anterior in both maxilla and mandible. PP and TPD tests also showed that the anesthetic effect varied between posterior divisions demonstrating extreme anesthesia compared to the anterior divisions. Conclusion: This technique was found to be successful for surgical extractions involving the maxillary and mandibular regions. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Management of procyonids often requires pharmacological restraint or general anesthesia. However, there are few studies describing anesthetic protocols in the Nasua nasua species, as well as regional anesthesia techniques. This case report describes the clinical presentation of a ring-tailed coati with bilateral mandibular instability, related to the surgical procedure to correct the mandibular symphysis disjunction and mandibule fracture, whose multimodal analgesia was based on premedication with ketamine (10 mg/kg), midazolam maleate (0.2 mg/kg) and methadone (0.2 mg/kg), induced anesthesia with dose-effect propofol and fentanyl (3 ug/kg), being maintained under general anesthesia with isoflurane associated with mandibular nerve block with 0.5% bupivacaine (0.15 mL/kg) and continuous infusion of fentanyl (5-15 ug/kg/h), for analgesic control. The protocol used was considered satisfactory, promoting adequate chemical restraint, anesthesia and analgesia for the osteosynthesis procedure, with a quick return to the animal's normal behavior and spontaneous post-operative feeding. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. Method and materials: This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Results: Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P < .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P < .001). Conclusion: Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients. [ABSTRACT FROM AUTHOR]

Background: In pursuit of improving currently available anesthetic techniques for dental procedures, present study evaluated a novel mandibular nerve block technique in comparison with control group administered standard inferior alveolar nerve block (IANB) technique. Methods: A randomized, comparative, parallel design, double-blind study was conducted at Tata Main Hospital, Jamshedpur, India which enrolled 140 adult patients (70 in experimental group and 70 in control group) requiring minor surgical dental procedures involving normal forceps method extractions of mandibular molars. Tingling or numbness of the lower lip of the same side was considered suggestive of successful IANB blockage. Onset of anesthesia, aspiration of blood and failure of anesthesia were also assessed and compared between study groups. Results: Mean age and gender distribution were statistically comparable between study groups (p > 0.05). Diagnosis of the enrolled cases was either acute or chronic apical periodontitis, which was distributed similarly in study groups (p > 0.05). Mean time to onset of the IANB blockage was found to be significantly longer in experimental group versus control (3.72 ± 0.84 versus 1.93 ± 0.62 min, p < 0.05). Both, number of positive aspirations (7.14% versus 25.72%, p < 0.05) and need for additional injection were significantly lower in experimental group (18.58% versus 74.28%, p < 0.05). Incidence of pain while tooth removal was similar between study groups (p > 0.05). Conclusion: The novel technique for mandibular nerve block evaluated in present study has various advantages like avoidance of technical difficulties with absence of extra-oral landmark, lower chances of reinsertion reducing complication risk, and decreased systemic complications, evident by lower rates of aspirations. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Academia Mexicana de Odontología Pediátrica (2594-1798) is the property of Academia Mexicana de Odontologia Pediatrica, A. C. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Adequate postoperative pain relief after gap arthroplasty is usually managed by intravenous opioids and NSAIDs with their inherent side effects. Mandibular nerve block provides good quality and long lasting analgesia. Use of peripheral nerve stimulator aids the block in cases with distorted anatomy. Methods We describe the use of peripheral nerve stimulator for extra-oral mandibular nerve block in patients undergoing temporomandibular surgery. Results Since the peripheral nerve stimulator provides an objective identification of the nerve, the success is close to 100%. Pain relief is excellent with reduction in intraoperative and postoperative consumption of opioids and NSAIDs. Postoperative pain relief lasts for at least 8 h and reduces subsequent requirement of analgesics. Conclusion Peripheral nerve stimulator is a sure, safe and easy option available for mandibular nerve block in patients undergoing temporo-mandibular surgery especially with distorted anatomy. [ABSTRACT FROM AUTHOR]

Blockade of the trigeminal nerve and its branches at various locations is a well-established procedure to treat intractable pain syndromes in the distribution of the nerve. Mandibular nerve block is a commonly performed procedure by anesthesiologists, pain physicians, as well as dental practitioners. As it is considered to be a safe procedure, it is usually performed in an outpatient setting with or without monitoring. The complications associated with mandibular nerve block include intravascular injection, hypoesthesia, dysesthesia, sensory loss in mandibular nerve distribution, facial swelling, weakness of the masseter muscle, and injury to the auditory tube leading to severe vertigo. Here, we present an uncommon complication during mandibular nerve block with lignocaine in a patient of trigeminal neuralgia who suffered transient asystole during the procedure. The case highlights the importance of monitoring and emphasizes the need for additional precautions to be taken during pain procedures particularly in high-risk populations such as geriatric patients.

Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

Purpose: A successful inferior alveolar nerve block anesthesia necessitates knowledge of the exact location of the mandibular foramen. The aim of this study was to determine whether the location of the mandibular foramen is related to the age or the vertical facial morphology of the patient. Methods: Lateral cephalometric radiographs from 145 patients (average age 10.4 years; range 63 to 14.6 years) were collected. The position of the mandibular foramen was investigated both antero-posteriorely and vertically in relation to the ocdusal plane. Pearson's correlation and multiple regression analysis were performed between the variables under study. Results: The mandibulor foramen was horizontally located at 60 percent of the ramus width from its anterior border. The vertical distance of the mondibulor foramen from the occlusal plane was significantly correlated to all examined variables, especially to the patient's age (r=0.69, P<0.00l}. the inter-maxillary angle (r=-0.60, P<0.00l), and the lower facial anterior soft tissue ratio (r=-0.76, P<0.00l). Multiple regression analysis explained more than 70 percent of the variation of the vertical position of the mandibular foramen. Conclusions: Taking into consideration the age and the facial morphology of the patient may help better locate the mandibular foramen, which is a prerequisite for a successful and safe irferior alveolar nerve block. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The main procedure specific complication of sagittal split osteotomy of the mandibular ramus (SSOMR) is inferior alveolar nerve (IAN) injury. This can be produced by poor intraoperative visibility of the IAN due to bone bleeding. In our centre, mandibular nerve blocks (MNBs) are usually performed for intra- and post-operative analgesia. We observed that MNB seems to decrease intraoperative bleeding and thus to improve IAN visibility. Our study was performed to evaluate the effect of MNB on intraoperative bleeding during SSOMR and, secondarily, on the duration of this procedure. Material and methods: Patients scheduled for bilateral SSOMR under general anaesthesia were prospectively randomized into two groups. The Block group received bilateral MNB (5mL ropivacaine 0.5% for each block) and the Control group sham MNBs (bilateral cutaneous puncture, without block). The operations were carried out under a standardised general anaesthetic. Post-operatively, the surgeon, blinded to group allocation, assessed intraoperative bone bleeding using a Numerical Rating Scale (NRS) (0: no bleeding, perfect visibility to 100: major bleeding, no visibility). Osteotomy duration, intraoperative anaesthetic requirements, and pain score in the recovery room were also recorded. Results are expressed as median [25–75th percentiles]. Results: Nineteen patients were included in each group. Osteotomy under MNB had a decreased intraoperative bone bleeding score compared with controls (20 [0–40] versus 55 [20–80], p =0.0002). They had a dry surgical field more frequently (29% versus 5%, p =0.01), and a shorter mean time for the osteotomy (15 [12.25–17.75] versus 17.5 [15–21]min, p =0.009). Block patients had reduced intraoperative opioid consumption (770 [678–1430] versus 2310 [1908–3058]mcg of remifentanil, p =0.0001), and lower pain scores in the recovery room (0 [0–2] versus 3 [1–5], p =0.12). Conclusion: MNB decreases intraoperative bone bleeding during SSOMR under general anaesthesia. Three hypotheses to explain this result are discussed. [Copyright &y& Elsevier]

We describe the use of peripheral nerve stimulator for mandibular nerve block intraoperatively in a 4.5year old child with complete temporomandibular joint ankyloses. The block was not possible preoperatively, therefore, it was administered after release of ankyloses. The use of peripheral nerve stimulator increased the chances of a successful block. No intraoperative analgesics and muscle relaxants were required. Postoperative pain relief was excellent. Peripheral nerve stimulator is an easy way of for accurate needle tip placement for mandibular nerve block in patients with distorted anatomy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the perception of pain and time of onset in relation to mandibular alveolar nerve block administered by a computerized anesthesia delivery system (ie, The Wand) and a traditional anesthesia system (ie, the syringe). Methods: This study was conducted according to a split-mouth design, with both types of injections being given to all patients. Subjects consisted of 33 patients between 7 and 18 years of age requiring local anesthesia for dental restorations in both sides of the mandible. All patients were blindfolded, and the sound from the Wand machine was activated during both types of administration. Topical analgesic was placed in the area of the injection site in all cases. Pain ratings were obtained using a 10-point visual analog scale (VAS). Time of onset was measured, from withdrawal of the needle to numbness of the lower lip was reported. Results: The computerized anesthesia delivery system resulted in significantly lower pain ratings than the traditional syringe. No difference could be found in time of onset between the 2 methods. Conclusions: Mandibular alveolar block analgesia seems to be less painful when using The Wand than when using a traditional syringe. [ABSTRACT FROM AUTHOR]

Pain is a problematic symptom in patients with osteonecrosis of the jaws (ONJ). Effective pain management in patients with advanced ONJ still remains an unresolved issue. This case series report presents three patients who were referred to the pain clinic for treatment of intractable pain caused by ONJ. Two patients received mandibular nerve blocks and achieved pain relief. After referral to the pain clinic, these two patients underwent segmental mandibulectomy for ONJ. In the third patient, the effect of pain control was limited. Appropriate cooperation between the oral and maxillofacial surgeon and the pain specialist is essential for pain management in patients with advanced ONJ who experience intense pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hiraoka et al.)

Analgesia is essential for successful completion of modern dental procedures. Standard inferior alveolar nerve block (IANB) is the primary method used to achieve mandibular analgesia. Difficulty experienced in obtaining satisfactory analgesia after IANB, especially of an acutely inflamed mandibular molar, remains a common clinical problem. Even when a proper technique is employed, clinical studies show that IANB fails an approximately 30% to 45% of cases. The reasons for failure are not fully understood. Anatomical considerations and abnormal physiological responses in the presence of inflammation as explanations for IANB failure are discussed in this paper. [ABSTRACT FROM AUTHOR]

Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours. [ABSTRACT FROM AUTHOR]

We report the case of a middle-aged woman who developed trigeminal neuralgia as a sequela of multiple sclerosis (MS). The trigeminal neuralgia was refractory to medications and persisted for two years. Eventually, it was resolved by a mandibular nerve block followed by natalizumab administration. The pain was controlled for 23 months, and additional nerve blocks were not required during this period. It has been previously reported that natalizumab therapy improves the Expanded Disability Status Scale (EDSS) scores and health-related quality of life in patients with MS. In the present case, natalizumab may have prolonged the effect of the mandibular nerve block and consequently improved the patient's quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Norioka et al.)