Infraorbital Nerve Block for Conchotomy Pain: A Case Report

Abstract

Background: Post-operative pain following nasal surgery commonly results from mucosal injury, periosteal irritation, and bony procedures such as osteotomy, and is often worsened by nasal packing. Moderate pain levels are frequently reported on the first post-operative day, emphasizing the importance of multimodal analgesia. Infraorbital nerve block has been shown to reduce pain scores, opioid consumption, and soft-tissue edema in various nasal procedures. Ultrasound guidance enhances accuracy and safety, while adjuvants such as dexamethasone may prolong analgesic duration.

Case: A 33-year-old woman presented with a one-year history of bilateral nasal obstruction, persistent post-nasal drip, and right-sided aural discharge. She had a history of left tympanoplasty and right superior conchotomy. Preoperative evaluation revealed normal physical findings, normal laboratory values, and ASA physical status I. The patient underwent elective bilateral inferior turbinate conchotomy under general anesthesia supplemented with bilateral ultrasound-guided infraorbital nerve blocks using 4 mL of 0.25% bupivacaine and 4 mg dexamethasone on each side. Intraoperatively, vital signs remained stable, and no additional opioids were required.

Discussion: Infraorbital nerve block provides sensory blockade to the nasal septum, lateral nasal wall, upper lip, and anterior cheek through branches of the maxillary nerve. Evidence from randomized trials and recent meta-analyses shows significant reductions in pain scores and analgesic requirements following nasal surgery. The addition of dexamethasone may further prolong block duration. In this case, the block resulted in minimal post-operative pain (NRS 1/10) and eliminated the need for opioids. Pain control was maintained with oral paracetamol and ibuprofen alone, with no complications observed.

Conclusion: Bilateral ultrasound-guided infraorbital nerve block is a safe and effective adjunct for perioperative analgesia in inferior turbinate conchotomy. This technique may reduce opioid requirements, improve patient comfort, and support enhanced recovery after nasal surgery.