A 74-year-old male was diagnosed with osteomyelitis of the left mandible requiring marginal mandibulectomy under general anesthesia. However, the patient’s pulmonary function tests demonstrated findings consistent with severe chronic obstructive pulmonary disease, classified as stage III. The consulting pulmonologist explained the increased risk of respiratory complications associated with general anesthesia and advised against its use. Therefore, we opted to perform the surgery under moderate sedation using 0.2% ropivacaine administered via bilateral ultrasound-guided inferior alveolar nerve blocks (UGIANBs) and an indwelling catheter with a pump for continuous perioperative local anesthesia and prolonged postoperative analgesia. This approach delivered excellent local anesthetic effects without any need for rescue medications or complications. Use of UGIANBs along with an indwelling catheter and pump may provide adequate local anesthesia and postoperative analgesia in patients with contraindications for general anesthesia.
Preoperative Panoramic Radiograph.
Panoramic radiograph illustrating osteomyelitis of the left mandible.
Ultrasound Imaging Before Needle Insertion.
Ultrasound image illustrating the pterygomandibular space. Cor, coronoid; Con, condyle; M, masseter; PMS, pterygomandibular space.
Positioning of Ultrasound Probe and Needle.
Ultrasound probe and needle used to perform percutaneous nerve block positioned on a skull model.
Ultrasound Imaging During Injection.
Ultrasound image illustrating the needle and spread of local anesthetic solution. Cor, coronoid; Con, condyle; M, masseter; N, needle; LA, local anesthesia.
Catheter Insertion Through the Needle.
Needle is held in place as the flexible indwelling catheter is advanced.
Catheter Placement.
Photograph illustrates the flexible indwelling catheter taped securely into place.
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