Clinical Trials Logo

Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03799068
Other study ID # Cleft Palate
Secondary ID
Status Active, not recruiting
Phase N/A
First received
Last updated
Start date October 1, 2018
Est. completion date May 2019

Study information

Verified date January 2019
Source Assiut University
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

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.


Description:

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.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 60
Est. completion date May 2019
Est. primary completion date March 2019
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 1 Year to 5 Years
Eligibility Inclusion Criteria:

- ASA grade I-III.

- Aged from1-5 years

- Undergoing cleft palate repair.

Exclusion Criteria:

- Patient's refusal.

- Allergy to local anaesthetics.

- Trigeminal neuralgia.

- Bleeding diathesis.

- Inflammation or infection over injection site.

Study Design


Related Conditions & MeSH terms


Intervention

Other:
suprazygomatic maxillary nerve block
bilateral Suprazygomatic maxillary nerve block is performed before surgery in anaesthetized children, after aseptic preparation of the skin. The patient is in supine position with the head in neutral position. The puncture site is at the frontozygomatic angle, at the junction of the upper edge of the zygomatic arch and the frontal process. A 24G needle is attached to a syringe containing the local anaesthetic. It is advanced to reach the greater wing of sphenoid at approximately 20 mm depth, then withdrawn a few millimetres and redirected toward the nasolabial fold in a 20° forward and 10° downward direction. The progression in the pterygopalatine fossa is 35 to 45 mm. Loss of resistance after passing through the temporalis muscle assisted in determining the puncture depth. After a negative blood aspiration test, the calculated dose of the local anaesthetic is injected on each side.
surgical site infiltration
peri-incisional infiltration of bupivacaine around the incision site given by the surgeon on an anesthetized patient before the incision is done.

Locations

Country Name City State
Egypt Assiut university hospital Assiut

Sponsors (1)

Lead Sponsor Collaborator
Assiut University

Country where clinical trial is conducted

Egypt, 

Outcome

Type Measure Description Time frame Safety issue
Primary Pain assessment By Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) in Young Children (1-7 years) is a behavioral scale for evaluating postoperative pain in young children.
Cry No crying +1 Moaning,crying +2 Screaming+3
Facial expression: Smiling +1 Composed, neutral +2 Grimace +3
Verbal responses Positive statements +1 Negative statement +2 Suffering from pain +3
Torso Neutral/resting +1 Shifting, shivering, upright +2 Restrained +3
Legs Neutral position+1 Squirming/kicking, drawn up, tensed legs +2 Restrained +3 Cheops score of 4 or less indicates no pain. Rescue analgesic consisting of paracetamol 10-15 mg/kg will be given rectally when CHEOPS is > 4.
24 hours postoperative
See also
  Status Clinical Trial Phase
Not yet recruiting NCT05519592 - Proximal Lower Limb Intramuscular Block : Effects on Hemiparetic Gait N/A
Completed NCT04548076 - Thoracolumbar Interfascial Plane Block in Vertebral Surgery
Completed NCT04094987 - Interfascial Pressure Into Ultrasound Guided Anterior Quadratus Lumborum Block Application N/A
Recruiting NCT06247592 - Pulse Radiofrequency and Occipital Nerve Block for Chronic Migraine Patients N/A
Not yet recruiting NCT04544423 - Lumbar Erector Spinae Plane Block in Knee Prosthesis
Recruiting NCT05643040 - Comparison of Perioperative Analgesic Efficacy of Femoral Nerve Block, Adductor Canal Block and 4in1 Block N/A
Completed NCT03954249 - Evaluating the Effectiveness of Bilateral ESPB in Addition to Standard Analgesia at Reducing Opioid Consumption N/A
Not yet recruiting NCT06097286 - A Comparative Study Between Ultrasound Guided External Oblique Intercostal Plane (EOIP) Block and Erector Spinae Plane (ESP) Block for Postoperative Analgesia in Upper Abdominal Surgeries N/A
Recruiting NCT05937035 - Histological and Volumetric Evaluation of Customized Allograft Bone Blocks N/A
Completed NCT05278598 - 3 Ultrasound Guided Plane Blocks for Perioperative Analgesia in Patients Undergoing Radical Cystectomy N/A
Recruiting NCT04830280 - Effect Posterior QLB on Atelectasis N/A
Completed NCT04824833 - Effects of US-guided SAPB During Breast Surgery N/A
Not yet recruiting NCT06423677 - Analgesic Efficacy of Serratus Posterior Superior Intercostal Plane (SPSIP) Block in Shoulder Arthroscopies N/A
Withdrawn NCT05237479 - Suprainguinal Fascia Iliaca Compartment Block in Direct Anterior Approach to Total Hip Arthroplasty N/A
Completed NCT04733313 - Effect of Quadratus Lumborum Block in C/S N/A
Withdrawn NCT04077398 - Volume vs Concentration: Quadratus Lumborum Blocks With High Volume/Low Concentration or Low Volume/ High Concentration in Nephrectomies Phase 4
Completed NCT03024697 - Single-shot Pectoral Plane(PECs) Block Versus Continuous Local Anaesthetic Infusion Analgesia or Both PECS Block and Local Anaesthetic Infusion After Breast Surgery: A Prospective Randomised, Double-blind Trial Phase 4
Completed NCT01740453 - Effect of Interscalene Block on Ventilatory Function Phase 4
Recruiting NCT06265402 - Retrolaminar Block Versus Tab Block in Abdomioasty N/A
Completed NCT05888285 - Erector Spina Plane Block and Radiofrequency Treatmen N/A