Ultrasound-guided suprazygomatic maxillary nerve block in cleft palate surgery: The efficacy of adding dexmedetomidine to bupivacaine

Abstract

ABSTRACT We have hypothesized that adding dexmedetomidine to bupivacaine in bilateral ultrasound-guided suprazygomatic maxillary nerve block (SMB) would provide prolonged postoperative analgesia following cleft palate (CP) repair. Children posted for CP repair were randomized to receive bilateral ultrasound-guided SMB, with either 0.15 ml/kg 0.25% bupivacaine on each side (B group; n = 40) or 0.5 µg/kg dexmedetomidine plus 0.15 ml/kg 0.25% bupivacaine on each side (BD group; n = 40). Children and Infants Postoperative Pain Scale (CHIPPS) was the primary outcome, the number of children required analgesia, the first time of rescue analgesia, the total nalbuphine consumption, sedation score, and time to feed were recorded. CHIPPS score was comparable between the two groups in the first 6 hours. However, it was significantly less in BD group than B group at 8 h, 12 h, 16 h, 20 h and 24 h postoperatively as well as the number of children required analgesia (7 vs. 26, respectively; P < 0.001) with delay of the first analgesic request (23.6 vs. 14.9 h) and reduced the total nalbuphine consumption (0.3 ± 0.7 vs. 2.1 ± 1.8 mg). Sedation score was higher in group BD at Postoperative Anesthesia Care Unit (P = 0.037). Time to feed was similar between both groups (P = 0.376). In bilateral SMB, the use of 0.5 µg/kg dexmedetomidine as an adjunct to bupivacaine 0.25% was associated with prolonged postoperative analgesia and decreased total analgesic consumption in children assigned for surgical correction of CP.