Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children: a prospective, randomized,
Julien Chiono1, Olivier Raux, Sophie Bringuier
1From the Department of Anesthesiology and Critical Care Medicine, University Montpellier I, and Lapeyronie University Hospital, Montpellier, France.
Insights
Bilateral suprazygomatic maxillary nerve block (SMB) with ropivacaine effectively reduced morphine use and continuous infusion needs in infants after cleft palate repair. This regional anesthesia technique may also decrease postoperative respiratory complications.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Investigating pain management strategies for infants undergoing cleft palate repair.
- Evaluating the efficacy of bilateral suprazygomatic maxillary nerve block (SMB) for postoperative pain relief.
Purpose of the Study:
- To assess the effectiveness of bilateral SMB in reducing postoperative morphine consumption in pediatric cleft palate repair.
- To compare pain scores and complications between ropivacaine and saline groups.
Main Methods:
- A prospective, double-blind, randomized controlled trial involving 60 children.
- Bilateral SMB was administered with either 0.2% ropivacaine or isotonic saline.
- Primary endpoint: total postoperative morphine consumption at 48 hours.
Main Results:
- The ropivacaine group showed significantly lower total morphine consumption compared to the saline group (P=0.033).
- Continuous morphine infusion was less frequent in the ropivacaine group (3.6% vs. 31%, P=0.006).
- Fewer respiratory complications, such as oxygen desaturation, were observed in the ropivacaine group.
Conclusions:
- Bilateral SMB is a simple regional anesthesia technique for pediatric cleft palate repair.
- It effectively reduces postoperative morphine requirements and the need for continuous infusion.
- The technique may also mitigate postoperative respiratory complications.
Background:
The authors investigated the efficacy of bilateral suprazygomatic maxillary nerve block (SMB) for postoperative pain relief in infants undergoing cleft palate repair.
Methods:
In this prospective, double-blind, single-site, randomized, and parallel-arm controlled trial, 60 children were assigned to undergo bilateral SMB with general anesthesia with either 0.15 ml/kg of 0.2% ropivacaine (Ropi group) or 0.15 ml/kg of isotonic saline (Saline group) on each side. The primary endpoint was total postoperative morphine consumption at 48 h. Pain scores and respiratory- and SMB-related complications were noted.
Results:
The overall dose of intravenous morphine after 48 h (mean [95% CI]) was lower in the Ropi group compared with that in the Saline group (104.3 [68.9 to 139.6] vs. 205.2 [130.7 to 279.7] μg/kg; P = 0.033). Continuous morphine infusion was less frequent in the Ropi group compared with that in the Saline group (1 patient [3.6%] vs. 9 patients [31%]; P = 0.006). Three patients in the Saline group had an episode of oxygen desaturation requiring oxygen therapy. There were no technical failures or immediate complications of the SMB. Intraoperative hemodynamic parameters, doses of sufentanil, pain scores, and postoperative hydroxyzine requirements were not different between the two groups.
Conclusion:
Bilateral SMB is an easy regional anesthesia technique that reduces total morphine consumption at 48 h after cleft palate repair in children and the use of continuous infusion of morphine and may decrease postoperative respiratory complications.
More Related Videos
05:54Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla
Published on: October 18, 2021
06:13Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018