الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Reconstructive surgery of the head and neck poses a significant challenge for achieving a good cosmetic and functional outcome. There are different techniques for reconstruction like primary closure of the defect, regional or local pedicle skin flaps and free flaps. Owing to its role in haemodynamic stability and regional blood flow, anaesthesia can be a significant and determining factor in the technique success.
Paravertebral block has shown a beneficial effect following reconstruction surgery. It provides adequate blood supply due to its sympatholytic effect, which in turn avoids vasospasm for vessels with possible compromised circulation. It leads to somatic and sympathetic ipsilateral nerve blockade in various adjacent dermatomes above and below the injection site.
The aim of the present study was to evaluate the effect of paravertebral block on survival of maxillofacial rotational flap.
The present prospective, randomized, controlled, and blind study was carried out in Alexandria Main University hospital on 32 adult patients aged between twenty and sixty years, of both sex and ASA physical status class II or III with extra-oral maxillofacial defects scheduled for rotational flap reconstruction under general anaesthesia.
The following exclusion criteria were applied: Patients with hypersensitivity to local anaesthetics, vertebral column anomalies, coagulation disorder and patients with intraoral defects in order to exclude the thermal effects of the inside of the mouth when recording the flap skin temperature.
Patients were randomly categorized using closed envelope method into two equal groups (16 patients each): patients in group I received ultrasound guided paravertebral block at T1 and T2 levels (single shot of 20-25 ml local anaesthetic including 5 ml lidocaine 2% and 15-20 ml bupivacaine 0.5%) in addition to conventional general anaesthesia, while patients in group II received conventional general anaesthesia without paravertebral block.
Evaluation of patients was carried out through proper history taking, clinical examination and routine laboratory investigations including complete blood picture, coagulation profile, blood urea, serum creatinine, serum electrolytes, fasting blood glucose, liver function tests and any other investigation needed. Patients were instructed on the proper use of the visual analogue scale (VAS) for assessing pain. group I patients received US guided paravertebral block. Every patient was informed about the procedure of US guided PVB. After assessing the efficacy of the block, standard general anaesthesia was induced.
Induction of general anaesthesia was carried out with fentanyl citrate (1 µg/kg) IV and propofol (2 mg/kg) injected slowly till loss of verbal communication. Endotracheal intubation was facilitated by rocuronium bromide (0.6 mg/kg) IV. Anaesthesia was maintained with 1.2% isoflurane in 100% O2. Incremental doses of fentanyl were administered and intermittent boluses of rocuronium (0.1 mg/kg) were given.