Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Regional Anesthesia

Background:

• Cleft palate surgery in children requires effective pain management.
• Regional anesthesia techniques can enhance multimodal analgesia strategies.
• The suprazygomatic maxillary nerve (SZMN) block offers a potential approach for intraoperative and postoperative analgesia.

Purpose of the Study:

• To evaluate the clinical anatomy, safety, and effectiveness of the suprazygomatic maxillary nerve (SZMN) block in pediatric patients undergoing cleft palate surgery.
• To describe the anatomical landmarks and procedural steps for performing the SZMN block.
• To assess peri-procedure complications and postoperative opioid requirements associated with the SZMN block.

Main Methods:

• Observational case series conducted at a single UK cleft center.
• Included pediatric patients (9 months to 18 years) undergoing palatal surgery.
• Suprazygomatic maxillary nerve (SZMN) block with ropivacaine 0.2% was introduced into the clinical protocol.

Main Results:

• Detailed stepwise and pictorial description of the SZMN block's clinical anatomy.
• 43 patients underwent palatal surgery; 21 received the SZMN block in addition to general anesthesia and local infiltration.
• No local or systemic complications were observed with the SZMN block; no significant difference in postoperative opioid use between groups (P=.79).

Conclusions:

• The suprazygomatic maxillary nerve (SZMN) block is a feasible and safe regional anesthesia technique for pediatric cleft palate surgery, even without ultrasound guidance.
• Regional anesthesia should be considered as part of multimodal analgesia in this patient population.
• Demonstrating a significant reduction in opioid use may be challenging in settings with established enhanced recovery protocols and low baseline opioid consumption.