Bilateral suprazygomatic maxillary nerve block versus palatal block for cleft palate repair in children: A randomized controlled trial

Background and objectives: Airway obstruction and respiratory compromise are frequently encountered complications of cleft palate (CP) repair. We compared the analgesic efficacy of bilateral suprazygomatic maxillary nerve block (SMB) versus palatal block (PB) in pediatric patients undergoing CP repair. Methods: 90 patients aged 3-24 months were allocated into three groups: Control group (C): patients received general anesthesia only. Maxillary block group (M): patients received ultrasound-guided bilateral SMB using 0.15 ml/kg bupivacaine 0.25%. Palatal block group (P): 0.5 ml bupivacaine 0.25% was injected bilaterally at greater, lesser and nasopalatine foraminae. CHIPPS score, rescue analgesic consumption and time till tolerance of oral feed were assessed. Results: On admission to PACU till 8 h postoperative, CHIPPS score was lower in M and P groups compared to C group. At 6 h and 8 h, CHIPPS score was lower in M group compared to P group. Postoperative rescue analgesic consumption was decreased in M and P groups (0.72 +/- 2.22 mg) and (3.73 +/- 5.92 mg) compared to C group (8.07 +/- 5.47 mg) with significantly lower values in M group compared to P group. Time to first request of rescue analgesia was significantly prolonged in M and P groups (482.50 +/- 38.62 min) and (260.00 +/- 31.62 min) compared to C group (79.71 +/- 30.34 min). Time to feed was lower in M and P groups compared to C group. Conclusion: Ultrasound-guided bilateral SMB provided better postoperative analgesia and decreased rescue analgesic consumption and time to tolerate oral feeding compared to PB without increased side effects.