Research Summary

Ultrasound-Guided Iliac Fascia and Trigeminus Block Reduces Pain After Head-and-Neck Tumor Surgery with Free Flap Reconstruction

Miranda Manier, BA

Key Highlights

  • In a randomized controlled trial of 145 patients undergoing head-and-neck tumor resection with free flap reconstruction, ultrasound-guided iliac fascia plus trigeminus block anesthesia significantly reduced postoperative pain.
  • Patients in the nerve block group achieved earlier out-of-bed mobilization compared with controls.
  • Elevated interleukin-6 expression was associated with reduced efficacy of the nerve block protocol.

A prospective randomized controlled trial evaluated whether ultrasound-guided iliac fascia combined with trigeminus nerve block anesthesia could improve postoperative pain control in patients undergoing radical head-and-neck tumor resection with simultaneous vascularized anterolateral femoral free flap reconstruction. Findings demonstrated that the nerve block protocol significantly reduced pain and facilitated earlier mobilization, although its efficacy was diminished in patients with elevated interleukin-6 (IL-6) expression.

Head-and-neck tumor resections requiring free flap reconstruction are complex procedures associated with considerable postoperative pain. Effective pain management is important not only for patient comfort but also for enabling recovery, mobilization, and functional outcomes such as speech and swallowing. Regional anesthesia techniques, particularly those guided by ultrasound, have been investigated as potential adjuncts to systemic analgesia, but evidence specific to combined iliac fascia and trigeminus block in this surgical population has been limited. This study aimed to address that gap.

A total of 145 patients aged 18 to 85 years were enrolled, with a mean age of 58.4 years; 70.3% were male. All patients underwent radical tumor resection with anterolateral femoral free flap reconstruction. Participants were randomized to receive either ultrasound-guided iliac fascia and trigeminus nerve block anesthesia (nerve block group, n = 71) or no nerve block (control group, n = 74). The primary endpoint was faciocervical pain while speaking, measured using the visual analog scale (VAS) during the perioperative period and up to 7 days postoperatively. Secondary outcomes included time to out-of-bed mobilization and evaluation of biomarkers such as IL-6 expression. Statistical analysis included linear mixed-effects modeling, logistic regression, and nonparametric tests, with significance set at P < .05.

Results showed that nerve block anesthesia significantly reduced postoperative pain, with a mean VAS score of 0.99 ± 1.72 compared with controls (P < .0001). Patients in the nerve block group also achieved earlier mobilization, with out-of-bed activity beginning at 47.45 ± 19.68 hours versus longer in the control group (P = .017). Importantly, elevated IL-6 expression was associated with reduced analgesic efficacy of the protocol (P = .0176), suggesting an inflammatory influence on treatment response.

“Ultrasound-guided iliac fascia combined with trigeminus block anesthesia is an effective method for pain management in patients who underwent head-and-neck tumor surgery in conjunction with the simultaneous repair using the vascularized anterolateral femoral free flap,” Bao and colleagues concluded.

Reference
Bao M, Zhang D, Liu L, Lin J, Zhao L, Li C. Ultrasound-guided nerve block anesthesia improves perioperative pain in patients undergoing free flap reconstruction for head-and-neck tumor: a randomized, controlled trial. Trials. 2025;26(1):345. doi:10.1186/s13063-025-09079-z