Suprazygomatic Block in Cleft Palate Surgery in Children
Status:
Completed
Trial end date:
2018-08-31
Target enrollment:
Participant gender:
Summary
Cleft palate (CP) is a common congenital malformation, with an incidence ranging from 0.1 to
1.1 per 1000 births depending on the population group (liau et al, 2010). Early surgery is
necessary to reduce phonation and feeding difficulties and reduce complications such as
frequent sinusitis and other respiratory tract infections (Takemura et al., 2002).
CP repair is painful, necessitating high doses of intravenous (I.V.) opioids. Therefore, the
risk of postoperative respiratory depression and airway obstruction is important, and
continuous monitoring is required during the initial 48h postoperatively (Roulleau et al,
2003).
Maxillary nerve block using the suprazygomatic approach is used in children since it presents
a lower rate of complications (Captier et al, 2009). By this way, one can reach the nerve as
it exits the skull at the foramen rotundum within the pterygopalatine fossa, before the
location where its nervous branches innervate the palate (Prigge et al, 2014). This simple,
reliable and almost risk-free approach can yield an effective and prolonged anesthesia with a
clear decreased use of morphine agents during and after cleft lip-palate surgery in small
children (Mesnil et al, 2010). The nerve block must be bilateral. The local anesthetic (LA)
is directly injected in the middle part of the fossa at a distance from the foramen rotundum
to avoid any trauma to the nerve or vascular injury, as soon as the tip of the needle has
crossed the temporal muscle (Binet et al, 2015).
Various adjuvants to local anesthetics to increase the duration of block are described in the
literature and used in the daily clinical practice. Dexmedetomidine is a selective alpha 2
(α2) adrenergic agonist with both analgesic and sedative properties. Animal studies showed
that perineural dexmedetomidine added to bupivacaine or ropivacaine prolongs the duration of
sensory and motor block (Brummett et al, 2011). Other clinical studies investigated the use
of dexmedetomidine in patients undergoing ulnar nerve, axillary brachial and greater palatine
nerve blocks, showed faster onset time and longer duration of block (Marhofer et al, 2013/
Esmaoglu et al, 2010& Obayah et al, 2010).