Background and Aims: The efficacy of bilateral nasociliary and maxillary nerve blocks combined with general anaesthesia on intraoperative opioids consumption, emergence and recovery outcomes in adult patients is not well established. We conducted this study to test the hypothesis that the above blocks, combined with general anaesthesia, decrease the intraoperative opioid consumption following nasal surgery. Methods: In this prospective, double-blinded, randomised controlled study, 51 adult patients undergoing elective nasal surgery under general anaesthesia were randomised into one of two groups. Group A ( n = 26) received bilateral nasociliary and maxillary nerve blocks with 12 mL of equal volumes of 0.5% bupivacaine and 2% lignocaine after induction of general anaesthesia. Group B ( n = 25) did not receive any block (control group). The primary endpoint was the total intraoperative dose of fentanyl consumed. The secondary endpoints were the grade of cough, emergence agitation, the grade of post-operative nausea and vomiting, time to the first analgesia and time to post-anaesthesia care unit discharge. Results: The mean total intraoperative fentanyl dose (μg) was significantly lower in group A than in group B (2.31 ± 11.76 vs. 41.20 ± 31.00, P = 0.00). The incidence of emergence agitation was lower in group A than group B (11.5% vs. 88%, P = 0.00). The time to the first analgesia was significantly longer in group A than group B (543.27 vs. 199.84 min, P = 0.017). Conclusion: The pre-emptive administration of bilateral nasociliary and maxillary nerve block for nasal surgery is an effective technique for reducing the intraoperative dose of fentanyl and emergence agitation.

Postherpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary infection with varicella-zoster. It is common with the intercostal nerve, which is easy to target and neurolysis. But PHN of L1 nerve dermatome is difficult to access for an isolated single nerve block. In our case, we had a 54-year-old male with severe L1 PHN (NRS pain score of 8-9/10), which was refractory to multiple drugs. A combined iliohypogastric/ilioinguinal nerve block did not produce any significant analgesic effect. We administered a transverse abdominis plane (TAP) block with a combination of local anesthetics and steroids to accomplish satisfactory analgesia. We repeated the block after 15 days to achieve an NRS pain score of 2/10 and later prescribed a minimal dose of duloxetine (10 mg once a day) only. The patient was followed up for 2 months with adequate pain relief. There were no side effects. We report this case to emphasize that fascial plane blocks could also prove fruitful in targeting specific nerves in cases of refractory PHN.