Peripheral Nerve Stimulator-guided extraoral mandibular nerve block effective for molar extractions: Study

A recent clinical study from SRM Kattankulathur Dental College and Hospital demonstrated that a Peripheral Nerve Stimulator (PNS)-guided extraoral mandibular nerve block offers superior and long-lasting analgesia during dental surgeries, particularly for mandibular third molar extractions. The major findings were published in the Journal of Maxillofacial and Oral Surgery.

Mandibular nerve blocks are a crucial technique for managing pain in complex dental procedures. However, their administration often presents challenges due to the uncertain surface landmarks and potential anatomical distortions. Thus, this study by Thivviyan Karthikeyan and team explored whether PNS guidance could improve the effectiveness and precision of this technique.

The prospective clinical trial involved a total of 42 patients, divided into 2 groups using computer-generated randomization. The control group received a conventional extraoral mandibular nerve block, while the test group underwent the procedure with PNS guidance.

The results of the study found that all patients in both groups reported complete anaesthesia during the procedure, with no need for supplemental injections. However, the PNS-guided group expressed significantly longer pain relief. Pain levels, assessed using the Visual Analogue Scale (VAS), remained low (≤2) for up to 6 hours after surgery in the test group.

The age of participants ranged from 19 to 52 years, with a mean age of 28.36 years. Out of the 42 patients, 25 were male, and 17 were female. Statistical analysis using paired t-tests and Wilcoxon signed-rank tests confirmed the superiority of the PNS-guided technique in maintaining prolonged anaesthesia and pain control.

The study highlights the potential for PNS-guided nerve blocks to revolutionize pain management not only for third molar surgeries but also for more complex maxillofacial procedures, such as cleft lip and palate repairs, orthognathic surgeries, and tumour removals.

Peripheral nerve stimulation ensures accurate nerve localization, enhancing both the effectiveness and safety of nerve blocks. This could change the approach of oral and maxillofacial surgery. Overall, the outcomes of this study point toward the broader adoption of PNS technology in clinical practice. 

Source:

Karthikeyan, T., Subramanian, A., Narayanan, V., & Seetaram, M. (2025). Does peripheral nerve stimulator-guided extraoral mandibular nerve block provide effective anaesthesia for third molar surgery: A prospective interventional study. Journal of Maxillofacial and Oral Surgery, 24(1), 267–273. https://doi.org/10.1007/s12663-024-02418-8