Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block
during pediatric primary cleft palate surgery: a randomized double-blind controlled study

Mostafa, Mohamed F.; Herdan, Ragaa; El-Shazly, Mohamed

doi:10.4097/kjae.2018.71.2.135

Cited by 16 publications

(35 citation statements)

References 23 publications

(27 reference statements)

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“…They concluded that the combination of dexmedetomidine and bupivacaine increased the analgesic duration after CP repair by 50% with no clinically relevant adverse effects. Mostafa et al [29] reported that the bilateral SMB is effective and safe for pain relief in children scheduled for primary CP repair surgeries with no severe side effects. They found that levobupivacaine is as effective as bupivacaine for SMB.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

et al. 2020

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Background: For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. Methods: Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 μg/kg dexmedetomidine (maximum volume 4 mL/side). Results: The modified children's hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. Conclusions: Addition of dexmedetomidine 0.5 μg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

et al. 2020

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“…Six of the 9 articles were prospective randomized clinical trials that reported multimodal management of postoperative pain in cleft lip and palate patients, and used opioids to manage postoperative pain. 7 , 8 , 11 – 13 , 15 These clinical trials reported a high statistical power in their studies (>80%) and included a total number of 321 patients. These studies evaluated the effect of multimodal analgesia by reducing the use of opioids that have been demonstrated to be efficacious in pain management.…”

Section: Resultsmentioning

confidence: 99%

“…Infraorbital, external nasal, and suprazygomatic nerve blocks have been used for pain management in these patients, and have resulted in good efficacy and low rates of adverse events. 7 , 8 , 11 …”

Section: Discussionmentioning

confidence: 99%

Is the Use of Opioids Safe after Primary Cleft Palate Repair? A Systematic Review

Rossell-Perry

Romero-Narvaez

Rojas-Sandoval³

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Pharmacologic treatment of postoperative pain after cleft palate repair includes opioids and nonopioid analgesics, nerve blocks, and local anesthetic infiltration. Use of opioids in infants has concerns regarding sedation, risk of aspiration, respiratory depression, and respiratory distress. The main objective of this review was to analyze information available on the safety of the use of opioids during perioperative management of pain related to primary cleft palate repair in published studies. Methods: A systematic review of the literature for studies published until March 2020 was performed to evaluate the safety of opioid drugs during primary cleft palate repair pain management. The authors chose the following MesH terms for this systematic review: cleft lip and palate AND opioids AND pain management. The investigators performed a systematic literature search using the Pubmed/MEDLINE, Embase, Web of Science, and Cochrane Library databases. Results: After a literature search resulting in 70 identified studies, 9 were qualified for the final analysis, which included 772 patients. There was a high level of evidence in the selected studies according to the Oxford CEBM Level of Evidence classification and GRADE scale. The most common adverse event reported was postoperative nausea and vomiting (from 5% to 25%). Episodes of oxygen desaturation have been reported from 2.5% to 7.4% of the studied patients. Conclusion s: Definitive conclusions about the safety of opioid drugs during primary cleft palate repair pain management cannot be drawn. Vomiting and oxygen desaturation have been associated with the use of opioids in the studied population.

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“…The maxillary nerve provides sensory innervation to the anterior and posterior palate, upper dental arch, maxillary sinus, and posterior nasal cavity. 9 The suprazygomatic approach to blocking the maxillary nerve has been shown to be effective at decreasing pain associated with trigeminal neuralgia and palatal surgery. 10,11 A double-blind randomized controlled trial showed a significant decrease in opioid consumption in cleft palate repair patients who received bilateral suprazygomatic maxillary nerve blocks.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 A double-blind randomized controlled trial showed a significant decrease in opioid consumption in cleft palate repair patients who received bilateral suprazygomatic maxillary nerve blocks. 9 By extension, orthognathic surgery in the form of Le Fort I maxillary advancement and/or distraction, involves the neurosensory distribution of the maxillary nerve. To our knowledge, this is the first study analyzing the effect of suprazygomatic maxillary nerve blocks on perioperative narcotic use in the setting of Le Fort I osteotomies.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery

Nores

Cuzzone

Hush

et al. 2020

FACE

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Aims: The mainstay of analgesia in orthognathic interventions for maxillary hypoplasia is perioperative opioids, however, the side effect profile is broad with the potential for well-described deleterious effects. The suprazygomatic maxillary nerve block has been previously shown to be effective in decreasing pain associated with palatal surgery. To date, there have been no studies detailing the use of maxillary nerve blocks as an adjunctive pain control measure during correction of maxillary hypoplasia. Consequently, we sought to evaluate the efficacy of intra-operative, ultrasound-guided bilateral suprazygomatic maxillary nerve blockade in decreasing postoperative narcotic consumption in patients undergoing Le Fort I level surgical orthognathic correction of cleft-related maxillary hypoplasia. Methods: Between January and December 2019, patients underdoing suprazygomatic maxillary nerve blockade for orthognathic correction of maxillary hypoplasia via either Le Fort I advancement or distraction were prospectively collected and compared to controls. Patient demographics, narcotic use (represented as morphine milligram equivalents per kg; MME/kg), self-reported pain scales, operative times, length of stay (LOS), and complication rates were compared. Results: Over the 12-month interval, 40 patients met inclusion criteria (n = 19 Block; n = 21 Control). Mean ages were 15.6 and 15.9 years, respectively. The block group demonstrated a significant reduction in postoperative narcotic requirements on POD1 and POD2 when compared to controls (POD1: 0.020 mg/kg vs 0.066 mg/kg, P < .005; POD2: 0.030 mg/kg vs 0.080 mg/kg, P < .016), with a trend toward significance thereafter. Corroboratively, self-reported pain scores in the first 24 hours were significantly decreased in the block compared to control groups with a trend toward significance thereafter (POD1: 1.13 vs 2.72, P < .001; POD2: 1.72 vs 2.56, P < .08; POD3: 1.21 vs 2.07, P < .06). LOS was decreased by an average of 1 day in the block group, operative times were unchanged, and neither group evidenced perioperative complication or return to service within 30 days. Conclusion: Administration of bilateral suprazygomatic maxillary nerve blocks in patients undergoing Le Fort I maxillary osteotomy for correction of cleft-related maxillary deficiency demonstrated a significant reduction in post-operative narcotic requirements, self-reported pain scales, and LOS without increased complications, suggesting its utility as a safe and effective analgesic adjunct in this patient population.

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Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study

Cited by 16 publications

References 23 publications

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

Is the Use of Opioids Safe after Primary Cleft Palate Repair? A Systematic Review

The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery

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