Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: a descriptive prospective study
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Published on: January 31, 2025
Chrystelle Sola1, Olivier Raux, Laurent Savath
1Department of Anaesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Insights
Ultrasound-guided suprazygomatic maxillary nerve blocks are feasible and effective for pediatric cleft palate repair, significantly reducing pain and opioid use. This technique offers a low failure rate and good clinical success for children undergoing this surgery.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Bilateral suprazygomatic maxillary nerve blocks enhance pain relief post-palate surgery.
- This study investigates the feasibility and efficiency of ultrasound-guided blocks in pediatric cleft palate repair.
Purpose of the Study:
- To evaluate the efficacy of ultrasound-guided suprazygomatic maxillary nerve blocks in children undergoing cleft palate repair.
- To assess the feasibility, local anesthetic spread, pain scores, and side effects of this technique.
Main Methods:
- Twenty-five children received bilateral ultrasound-guided suprazygomatic maxillary blocks using 0.2% ropivacaine.
- Ultrasound was used to visualize the pterygopalatine fossa for accurate needle placement.
- Feasibility, local anesthetic spread, pain, and adverse events were recorded.
Main Results:
- Fifty blocks were performed with a high success rate (94% observed local anesthetic spread).
- Median block performance time was 56 seconds, with low median pain scores and nalbuphine consumption.
- 80% of patients avoided continuous opioid infusion, and no complications were reported.
Conclusions:
- Ultrasound guidance is a simple and effective tool for suprazygomatic maxillary nerve blocks in pediatric patients.
- The technique demonstrates a low technical failure rate and high clinical success in cleft palate repair.
- This method contributes to improved pain management in pediatric craniofacial surgery.
Background:
Bilateral suprazygomatic maxillary nerve blocks approach improves pain relief after palate surgery. We report the feasibility and efficiency of ultrasound-guided suprazygomatic maxillary nerve blocks in cleft palate repair in children.
Methods:
Twenty-five children scheduled to undergo surgical cleft palate repair were included. Ultrasound-guided suprazygomatic maxillary blocks were performed according to landmarks previously defined. The ultrasound probe was located optimally over the maxilla and under the zygomatic bone to visualize the pterygopalatine fossa. 0.15·ml·kg(-1) of 0.2% ropivacaine was injected bilaterally. Feasibility of block, spread of local anesthetic, pain scores and side effects were noted.
Results:
Fifty ultrasound-guided suprazygomatic maxillary nerve blocks were performed in 25 children. The needle movement was seen in all cases using an out-of-plane approach. The spread of LA was clearly observed in 94% (47/50) of cases. A poor ultrasound imaging was found in 4% (2/50), and the spread of LA was not identified in 2% of case (1/50). The median time to perform the block was 56 s (35-120 s). The median pain scores and consumption of nalbuphine were low during the study period. 80% of patients did not require continuous opioid infusion. No complication related to maxillary blocks was reported.
Conclusion:
With a very low technical failure rate and a good clinical success rate, ultrasound appears to be a useful and simple tool to aid suprazygomatic maxillary nerve block in children.
