Ultrasound-guided mandibular nerve block combined with superficial cervical plexus nerve block in patients undergoing radical surgery for tongue canceron: a randomized controlled trial

Abstract

Background: This prospective randomized controlled trial evaluates the effectiveness of bilateral mandibular nerve block and bilateral superficial cervical plexus nerve block under general anesthesia for patients undergoing extensive tongue cancer surgery. Given the considerable size of the surgical area and the prolonged duration associated with radical tongue cancer procedures, these factors significantly hinder postoperative recovery, particularly in elderly patients.

Methods: For this study, 60 patients scheduled for elective radical tongue cancer surgery were enlisted. These individuals were methodically allocated into three distinct groups through randomization: a group receiving both mandibular and superficial cervical plexus nerve blocks (MC group, n = 20), a group receiving only the mandibular nerve block (M group, n = 20), and a group subjected solely to the superficial cervical plexus nerve block (C group, n = 20).

Results: During the first 12 h postoperatively, VAS scores in groups M and C were significantly higher than those in group MC (P < 0.001). The proportion of patients requiring activation of the patient-controlled analgesia pump was greater in groups M and C (45% and 55%, respectively) than in group MC (10%; P = 0.021). Postoperative MAP and HR increased above baseline in groups M and C, and both parameters were significantly elevated compared with group MC (P = 0.03). At the time of tongue incision, group C differed significantly from group M (mean difference, 95% CI 2.43-8.17; P < 0.001) and group MC (mean difference, 95% CI 4.33-10.07; P < 0.001). QOR-15 scores at 24 h and 48 h postoperatively were higher in group MC (91.10 ± 4.98 and 92.65 ± 4.88, respectively) than in group M (83.50 ± 5.89 and 87.95 ± 5.59; P < 0.001) and group C (83.15 ± 6.24 and 88.90 ± 5.63; P < 0.001). Intraoperative remifentanil and sufentanil consumption was lower in group MC than in groups M and C (P < 0.001).

Conclusions: Utilizing ultrasound guidance for mandibular and superficial cervical plexus nerve blocks under general anesthesia substantially mitigates postoperative pain and enhances recovery rates following extensive tongue cancer surgeries, with no significant adverse effects observed.

Trial registration: China Clinical Trial Registration Center (registration number ChiCTR2400086380).

Keywords: Mandibular nerve block; Radical surgery for tongue cancer; Superficial cervical plexus nerve block; Ultrasound guidance.

Fig. 1

A Ultrasound-guided mandibular nerve block. The white arrows show the injection points, White dotted lines show puncture needles; B Ultrasound-guided superficial plexus nerve block. The white arrows show the injection points. White dotted lines show puncture needles. MM, Masseter Muscle; LP, Lateral Pterygoid; TM, Temporalis Muscle; LLOPP, Lateral lamina of pterygoid process; CA, Carotid Artery; SM, Sternocleidomastoid; LS, Levator Scapulae

Fig. 2

Flow chart of test grouping

Fig. 3

Comparison of vital signs of the three groups of patients at six different time points. Note: A mean arterial pressurein the three groups at different periods. A line graph represents the results. B Heart rate in the three groups at different periods. A line graph represents the results. T0: before induction of anesthesia; T1: 10 min before surgery; T2: at the time of skin incision; T3: at the time of cervical lymph node dissection; T4: at the time of tongue incision; T5: at the end of surgery; T6: 1 h after the end of surgery. Compared with T0, ^#P<0.05; compared with group M, ^aP<0.05; compared with group C, ^bP<0.05

Fig. 4

Comparison of VAS scores of patients in three group. Note: T7: 2h postoperatively; T8: 6h postoperatively; T9: 12h postoperatively; T10: 24h postoperatively; T11: 24h postoperatively. *P < 0.05, **P < 0.01,***P < 0.001 compared with Group MC