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. 2025 Jun;24(3):766-774.
doi: 10.1007/s12663-025-02505-4. Epub 2025 Mar 19.

Does the Addition of an Adjuvant Superficial Cervical Plexus Block to Inferior Alveolar Nerve Block Enhance Intraoperative Pain Control in Mandibular Third Molar Surgery? A Randomized Controlled Trial

Agalyah Kalyan Kumar  1 , Vivek Narayanan  2
Affiliations

Does the Addition of an Adjuvant Superficial Cervical Plexus Block to Inferior Alveolar Nerve Block Enhance Intraoperative Pain Control in Mandibular Third Molar Surgery? A Randomized Controlled Trial

Agalyah Kalyan Kumar et al. J Maxillofac Oral Surg. 2025 Jun.

Abstract

Introduction: Accessory innervation from the cervical plexus is attributed as a plausible explanation for inadequate pain control during surgical removal of mandibular impacted third molars. This study assessed the effectiveness of adjuvant superficial cervical plexus block (SCPB) to the conventional inferior alveolar nerve block (IANB) for managing intraoperative pain during mandibular third molar surgery.

Materials and methods: A double-blind, randomized trial with 64 patients undergoing mandibular third molar surgery was divided into two groups of 32 patients. Group A received IANB alone, while Group B received IANB with SCPB. Intraoperative pain was the primary outcome, measured by visual analogue scale. Pain on the first and fifth post-operative days was a secondary outcome. Paired t-tests analysed the data, with p < 0.05 indicating significance.

Results: Statistical analysis revealed that Group A patients who received only IANB had significantly higher VAS pain scores both during the intraoperative procedure and on the first post-operative day (P < 0.05) compared to Group B who received the adjuvant SCPB injection.

Conclusion: Combining SCPB with IANB effectively reduced intraoperative pain during mandibular impacted tooth removal and improved patient comfort on the first post-operative day. This highlights SCPB's value as an adjuvant for better pain management in mandibular third molar surgery.

Keywords: Accessory innervation; Adjuvant injection; Inadequate anaesthesia; Intraoperative pain control; Mandibular third molar surgery; Superficial cervical plexus block.

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Conflict of interest statement

Conflict of interestThe authors have no conflicts of interest to declare. The authors are solely responsible for the content and writing of the paper. The authors have no affiliation with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

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