Catheter-based local analgesia for the fractured mandible in a patient with a history of hereditary angioedema

Abstract

Hereditary angioedema is a rare genetic condition causing episodes of angioedema—including life-threatening laryngeal oedema. Episodes can be unpredictable, or triggered by factors such as trauma, drugs or dental treatment. When faced with a patient with a fractured mandible, who has had a severe attack of angioedema when prescribed either ibuprofen or codeine based analgesia, this required an alternative approach to analgesia. Using a catheter and local anaesthesia, we were able to keep the patient comfortable, and pain free.

Continuous mandibular nerve block as sole analgesia for postoperative pain management after a hemimandibulectomy in a French Bulldog

“…15 Mandibular nerve block can be used to improve pain management and increase quality of life in patients with mandibular fractures or tumours. 6,[9][10][11][12] The animal described in this case report was a brachycephalic geriatric dog with inappetence and weight loss. Due to the dog's condition, our main objective was to enhance the recovery and promote a fast return to normal function by providing adequate pain management and avoiding excessive postoperative sedation.…”

“…The transmission of noxious stimuli to the spinal cord and brain is prevented, thus providing analgesia 15 . Mandibular nerve block can be used to improve pain management and increase quality of life in patients with mandibular fractures or tumours 6,9–12 …”

“…6,8 In human medicine, cPNB of the mandibular nerve in patients with orofacial cancer pain or mandibular fractures has been described. [9][10][11] In veterinary medicine, a continuous mandibular nerve block using an epidural catheter placed in the mandibular canal has been reported in an alpaca. 12 Postoperative cPNB may then be used in an effort to reduce opioid use and decrease or exclude opioid-associated adverse effects, 12,13 especially in patients that may benefit from a rapid recovery.…”

Hereditary angioedema type II and dental extraction: case report and literature review

“…Certain drug treatments also appear to be a trigger. Hammond et al report a case of a patient with HAE type II after taking ibuprofen and codeine [5].…”

“…Early diagnosis of this disease is essential [11] although the lack of specificity of symptoms complicates the diagnosis [1]. In this context, most incidents during dental care have occurred in patients who were unaware of being a carrier of this disease [13,6,5,9]. HAE type II should be mentioned in the case of any clinical signs suggestive of the disease: isolated non-erythematous and non-pruritic angioedema, unexplained recurrent abdominal pain, recurrent oral edema or a family context [11].…”