Combined Nasociliary and Infraorbital Nerve Block: An Effective Regional Anesthesia Technique in Managing Nasal Bone Fractures

Background: Closed reduction of the fractured and displaced nasal bones results in nasal bleeding at the site of fracture which needs judicious management. Usually general anesthesia is used with orotracheal intubation, whereas managing these cases with combined nasociliary and infraorbital blocks needs a better understanding of the surface landmark and foraminal anatomy. Materials and methods: We report a randomized study of 2 groups of 25 patients each, with fractures of the nasal bones in our institution over 12 months. Group I included 25 patients with nasal bone fracture reduction done under general anesthesia, and group II included 25 patients in whom regional block anesthesia was given. Most of the patients in the study were in the ASA grade I and II and all had obvious nasal deformity observed and recorded with a history of trauma and injury. Results: The time for full sensory loss in group A was 45 minutes and 21 minutes in group B. The procedure time of 12 minutes was the same in both the groups, while an added imaging time of 15 minutes resulted in an overall procedure time of 27 minutes. Splints were used for septal support as well as externally, which needed an extra 20 minutes for the gypsum salt or the thermoplast to settle. The time of recovery was immediate in group B, while 20 minutes of recovery was seen in group A. Most of the patients in group A commented a painless recovery, while most patients of group B commented an experience of discomfort during the procedure. Conclusion: Unilateral fractures were reduced under regional block anesthesia. Comorbidities should overweigh compliance while preferring regional anesthesia, as the risks involved in general anesthesia have been reduced to the minimum possible extent. The regional block has reduced the operative costs but the complications of the procedure are nearly equal in both types of anesthesia.