Peri-Operative Pain Management for Cleft Lip Repair in Children, Bilateral Infraorbital Nerve Block Versus Combined Intravenous Fentanyl with Peri-Incisional Infiltration. A Randomized Comparative Study

Abstract

Background: The good control of postoperative pain has an important impact on the patient as regards his general condition, wound healing and hospital stay. Regional nerve blocks and systemic analgesics especially opioids offered this control but with superiority of the regional block due to avoidance of the side effects of opioids. The assessment of pain in pediatrics is difficult, as they usually do not have the ability to describe their pain. Pediatric patients undergoing cleft lip repair can benefit from nerve blocks related to the lip. Different types of analgesia were described, such as bilateral infraorbital nerve block (IONB), pharmacological analgesics and surgical site infiltration. Objective: To compare the effect of bilateral infraorbital nerve block with conventional methods (IV fentanyl and peri-incisional infiltration) as a proper perioperative pain management in children undergoing cleft lip (CL) repair operation. Patients and Method: Seventy-six children, scheduled for cleft lip repair, were enrolled in this study in Cairo University Pediatric Hospital (Abu El Reesh). The patients were randomly assigned into two groups: Group infraorbital nerve block IONB (n=38): received bilateral infraorbital nerve block. Group conventional (n= 38): received IV fentanyl with surgical site infiltration. Patients in both groups received general anesthesia and our interventions were performed after induction of anesthesia and before skin incision. Results: This study demonstrated that the use of bilateral IONB in children undergoing cleft lip repair was accompanied by superior levels of intraoperative and postoperative analgesia as compared to the use of IV fentanyl with surgical site infiltration in the same population. This difference was evidenced by significantly less need for postoperative rescue analgesia as well as lower pain scores up to 24 hours postoperative in the IONB group. Conclusion: This study results indicate that bilateral ION block is simple, safe and technically easy to perform with good postoperative analgesia.