Prospective Evaluation of Suprazygomatic Maxillary Nerve Block in Cleft Palate Repair

Abstract

INTRODUCTION: Nerve block techniques anecdotally provide superior analgesia while avoiding complications of opioids after cleft palate repair. We performed a prospective, randomized, controlled trial to compare the efficacy of a suprazygomatic maxillary nerve block (SMB) vs local anesthesia (LA) in decreasing postoperative opioid consumption. METHODS: Patients undergoing primary palatoplasty between March and November 2021 were randomized to receive either (1) SMB with 0.15 ml/kg of 0.2% ropivacaine per side and palatal injection of saline with 1:400,000 epinephrine or (2) LA using 2 ml/kg of 0.125% bupivacaine with 1:400,000 epinephrine. Paired t-tests compared pain scores (Face, Legs, Activity, Crying and Consolability [FLACC]), opioid consumption (morphine milligram equivalents [MME]), oral intake for the first 24 hours postoperatively (POD1), and length of stay (LOS; Table). Table. - A Comparison of Postoperative Outcomes Between the Nerve Block and Local Anesthesia Outcome parameter Local SMB p Value FLACC Scores POD1 2.60 1.64 0.04* Intraoperative MME 2.27 1.99 0.29 MME on POD1 2.21 1.55 0.24 Time to opioid administration (min.) 122.71 151.43 0.32 Time to oral intake (min.) 114.14 310.28 0.03* Total oral intake on POD1 (ml) 567.85 442.14 0.18 LOS (hrs.) 29 28.28 0.35 RESULTS: Fifteen patients met all study endpoints (n = 7 SMB; n = 8 LA). Mean ages at the time of repair were 11.96 (SMB) and 11.17 (LA) months. SMB patients demonstrated lower mean FLACC (1.64 SMB vs 2.60 LA; p = 0.04), yet no significant difference in MME (1.55 SMB vs 2.21 LA; p = 0.24) or in time to opioid administration postoperatively (151.43 min. SMB vs 122.71 min. LA; p = 0.32). SMB patients displayed longer time to oral intake postoperatively (310.3 min. SMB vs 114.1 min. LA; p = 0.03), but no difference in total intake (p = 0.18). CONCLUSION: SMB at the time of cleft palate repair may decrease postoperative pain scores, yet worsen the immediate ability to feed after surgery. Using pain scores to guide and standardize narcotic administration may lead to lower opioid consumption after SMB.