Ultrasound-guided infraorbital nerve block for cleft lip repair in pediatrics: a new technique for an old block

Background: One of the challenges that anesthesiologist faces is the intra- and postoperative analgesia in cases of cleft lip repair in pediatrics. However, the use of ultrasound infraorbital nerve (ION) block has not been evaluated before in pediatric. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of ultrasound-guided ION block in infants undergoing unilateral cleft lip repair. Methods: Sixty infants (ASA status I, II) aged 3-10 months undergoing unilateral cleft lip repair were allocated randomly to two groups (n=30 each). The bupivacaine group (group B) received ION block with 1ml 0.25% bupivacaine, and the saline group (group S) received 0.9% normal saline 1ml in each side by the use of ultrasound. Intraoperative measurements included heart rate and mean arterial blood pressure. Postoperative pain score was recorded at 15 and 30 min, then at 2, 6, 10, and 16 h. If the score exceeded 3 points, 25 mg/kg of paracetamol suppository was given, with recording the time of first rescue analgesia and total dose given in each group. Results: Postoperative pain, using FLACC (Face, Legs, Activity, Cry, Consolability) score the median scores were higher in the saline group than bupivacaine group at 15 min, 30 min, 2 h, 6 h and 10 h. There was significantly longer time in the bupivacaine group than the saline group for first rescue analgesia (476.6 +/- 100.7 vs 21 +/- 6 min respectively, P < 0.001). Whereas more number of paracetamol doses were required in the saline group when compared to bupivacaine group, total dose of paracetamol was significantly lower in the B group than the S group. Conclusions: Ultrasound-guided bilateral ION block provides a superior postoperative analgesia for infants undergoing cleft lip repair. It is a simple and easy to perform technique, with high success rate and minimal complications.