Study assesses Impact of Lingual Nerve Block on Hemodynamic Stability During Tongue Cancer Surgery: Study

Recently published randomized controlled trial involved 132 patients undergoing wide local excision of unilateral tongue cancer to evaluate the effectiveness of a lingual nerve block on managing haemodynamic surges and reducing opioid and volatile anaesthetic requirements. After recruitment, 14 patients were excluded due to protocol deviations, leaving a balanced comparison between two groups: one receiving a lingual nerve block (Group B) with 2 mL of 2% lignocaine, and the other receiving 2 mL of saline (Group A).

Results Overview

Results indicated that the maximum mean arterial pressure (MAP) and the maximum rises in systolic and diastolic blood pressure parameters were significantly higher in the control group, with p-values of 0.001 for all measurements. Although the maximum heart rate did not differ significantly between groups, the increase in heart rate from baseline was significantly greater in the control group. The total fentanyl consumption was also markedly higher in the control group compared to those receiving the nerve block, with p-values less than 0.001 for both immediate surgery and overall procedures that included neck dissection tasks.

NNT Analysis and Anaesthetic Depth

Notably, a number-needed-to-treat (NNT) analysis revealed an absolute risk reduction of 63.72%, indicating that for every 1.57 patients receiving lingual nerve blocks, one patient did not require extra fentanyl during tongue resection. In terms of anaesthetic depth, the maximum and mean minimum alveolar concentration (MAC) values used were also significantly higher in the control group (p < 0.001 and p = 0.019, respectively).

Conclusion on Effectiveness

Further, while total blood loss and Ramsay Sedation Score (RSS) in the post-anesthesia care unit were comparable across groups, the study concluded that lingual nerve block effectively mitigated increases in MAP and reduced opioid consumption during the surgical excision of tongue cancers. This aligns with previous research highlighting the advantages of regional anaesthesia in head and neck surgeries, not only improving analgesia and reducing dosages of opioids and anaesthetics but also possibly influencing postoperative recovery and cancer recurrence rates.

Discussion of Mechanism

The discussion section elaborated on the mechanism and expected benefits of lingual nerve block by noting that it targets critical innervation to the anterior two-thirds of the tongue. The common phenomenon of heightened systolic and diastolic pressure and heart rate when exising tumor tissue necessitates deeper sedation and increased opioid administration, which the nerve block addresses effectively. It cited earlier studies showing benefits of various nerve blocks in similar surgical contexts and reinforced that, unlike other blocks like the inferior alveolar nerve (IAN) and Gowgates block, the lingual nerve block offers unique advantages by minimizing unwanted sensation in adjacent areas while ensuring targeted anaesthesia.

Study Limitations

Limitations were noted, including the inability to track blood loss before and after specific phases of surgery, which might complicate interpretations of surgical blood loss comparison. There was a suggestion for further exploration of bilateral lingual nerve blocks to see if they provide improved outcomes regarding haemodynamic stability and opioid consumption.

Final Conclusion

In conclusion, using a lingual nerve block in tongue cancer surgeries proved effective in controlling haemodynamic responses while simultaneously reducing opioid and volatile anaesthetic requirements, providing a more stable surgical experience. The findings establish regional anaesthesia as a valuable adjuvant to manage perioperative risks associated with these sensitive and invasive procedures. More studies are warranted to explore implications for postoperative outcomes and longer-term cancer control related to anaesthetic strategies.

Key Points

- A randomized controlled trial involving 132 patients assessed the efficacy of lingual nerve blocks during wide local excision of unilateral tongue cancer. A total of 14 patients were excluded due to protocol deviations, resulting in two balanced groups: one receiving a lingual nerve block (Group B) and the other receiving saline as a control (Group A).

- Results indicated significantly higher maximum mean arterial pressure (MAP) and increases in systolic and diastolic blood pressure in the control group (p = 0.001), while the heart rate increase from baseline was also notably greater in the control group, despite no significant difference in the maximum heart rate between groups.

- Total fentanyl consumption was substantially lower in the lingual nerve block group, with p-values less than 0.001 for both immediate surgery and overall procedures, implying a strong reduction in opioid requirements due to the nerve block.

- A number-needed-to-treat (NNT) analysis showed an absolute risk reduction of 63.72%, indicating that for about every 1.57 patients treated with a lingual nerve block, one patient avoided needing extra fentanyl. Furthermore, the maximum and mean minimum alveolar concentration (MAC) values were significantly higher in the control group (p < 0.001 and p = 0.019, respectively).

- While no significant differences were observed between the groups concerning total blood loss and Ramsay Sedation Score (RSS) in the post-anesthesia care unit, the study concluded that lingual nerve block effectively reduced MAP surges and opioid consumption during tongue cancer surgeries, supporting the benefits of regional anaesthesia in head and neck operations.

- Study limitations included the inability to measure blood loss accurately across different surgical phases, and there was a recommendation for further studies on bilateral lingual nerve blocks to assess enhanced haemodynamic stability and opioid use. The findings reinforce regional anaesthesia as a critical approach for managing perioperative risks in sensitive surgical contexts.

Reference –

Shalini Chaudhuri et al. (2025). Efficacy Of Lingual Nerve Block In Preventing Haemodynamic Response Due To Surgical Stimulation In Patients Undergoing Tongue Cancer Resections: A Randomised Controlled Trial. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_1002_24.