Preoperative Suprazygomatic Maxillary Nerve Block to Reduce Perioperative Opioid Use in Pediatric Primary Cleft
Nina Wijnants1, Jan Hanot2, Lisa E Ramaut3
1Department of Plastic, Reconstructive and Hand Surgery, Cleft Team, Maastricht University Medical Center, MosaKids Children's Hospital.
Objective:
This explorative study aimed to investigate the potential association between preoperative ultrasound-guided suprazygomatic maxillary nerve block (SMNB) and reduced perioperative opioid consumption in pediatric patients undergoing primary cleft palate repair. The authors hypothesized that SMNB would decrease the need for opioid analgesics for perioperative pain management.
Design:
A retrospective cohort study. The control group underwent primary cleft palate repair without SMNB, while the intervention group received bilateral SMNB preoperatively.
Setting:
This study was conducted at the Department of Plastic Surgery, Maastricht University Medical Centre MosaKids Children's Hospital, a tertiary care institution.
Patients, Participants:
Twenty pediatric patients (below 2 y) were included. Ten received SMNB, and 10 historical controls were selected from an existing database.
Interventions:
The SMNB group received bilateral ultrasound-guided 0.15 mL/kg of 0.25% bupivacaine with adrenaline (1:200,000) under general anesthesia. The control group did not receive a regional nerve block.
Main Outcome Measures:
The primary outcome was perioperative opioid consumption (tramadol and morphine). Secondary outcomes included additional analgesic use (paracetamol, NSAIDs) and length of hospital stay.
Results:
Morphine consumption was significantly lower in the SMNB group (median 0.00 mg versus 0.75 mg, P=0.02), while tramadol use showed no significant difference (P=0.23). Secondary outcomes, including additional analgesic use and hospital stay, were not significantly different.
Conclusion:
Preoperative ultrasound-guided SMNB may be associated with reduced perioperative opioid consumption in pediatric primary cleft palate surgery. Larger, preferably randomized trials are needed to confirm its role in multimodal analgesia protocols.
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