Block Clinical Trial
Official title:
Comparative Study of Bilateral Suprazygomatic Maxillary Nerve Block and Surgical Site Infiltration for Perioperative Analgesia in Children Undergoing Cleft Palate Repair
The aim of this study is to evaluate the efficacy and duration of effect of bupivacaine given preoperatively as a bilateral suprazygomatic maxillary nerve block and to compare it with peri-incisional infiltration with the same agent for perioperative analgesia in children undergoing cleft palate repair.
Congenital cleft palate (CP) occurs in children at a rate of about 1.5 per 10 000 births,
Early surgery is necessary to reduce phonation and feeding difficulties and reduce
complications such as frequent sinusitis and other respiratory tract infections. The surgical
procedure can be complicated by airway obstruction and respiratory complications. CP is
painful in the first 24-48 h following surgery.
Different treatment modalities have been used for reducing or ameliorating the pain following
cleft palate repair. These include opioids, paracetamol, non steroidal anti-inflammatory
drugs (NSAIDs), surgical site infiltration and various nerve blocks However, the analgesic
drugs may provide inadequate analgesia and have side effects such as respiratory depression
and bleeding. The inherent disadvantages of analgesic pharmacotherapy in children promoted
interest in nerve blocking techniques for operative analgesia. These became established in
paediatric anaesthetic practice with the accumulating evidence of advantages such as
postoperative pain relief, reduced use of potent narcotics, rapid return of alertness, early
feeding and moving about, and early discharge in day care surgery.
The maxillary nerve, the second division of the trigeminal nerve, leaves the cranial part of
the face through the foramen rotundum, and then passes forward and laterally through the
pterygopalatine fossa, at the bottom of the pterygomaxillary fossa, and reaches the floor of
the orbit by the infra- orbital foramen. This sensory nerve supplies innervation of the lower
eyelid, the upper lip, the skin between them, the roof of the mouth, and the palate.
Maxillary nerve block through the infrazygomatic route, used for the treatment of trigeminal
neuralgia in adults, permits anesthesia of the entire palatine territory. However, this nerve
block has lead to complications such as orbital puncture, intracranial injection, maxillary
artery puncture, or posterior pharyngeal wall injury In adults, approach to the
suprazygomatic MN block (SMB) seems to minimize the risks of the infrazygomatic route
providing effective anaesthesia of the entire sensory territory of the MN and its terminal
branches.
Bupivacaine, a long-acting amide local anaesthetic has been used widely in infants,
particularly for infiltration of wound-edges and nerve blocking.
Pre-incisional infiltration of local anaesthetics has been used both in adults and children
in a variety of surgeries with variable results. submucosal infiltration performed by the
surgeon seems to alter surgical conditions. Maxillary nerve block using the suprazygomatic
approach has demonstrated beneficial effects in adults for trigeminal neuralgia.
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