From the Department of Anesthesiology, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain (GE, MDM, MdN), Department of Anesthesiology, Children's Hospital Colorado, Denver, Colorado, USA (GM, CC, RJI), Department of Pediatric Anesthesia, King Abdullah Hospital, Riyadh, Saudi Arabia (PS), Department of Anesthesiology, Guwahati Comprehensive Cleft Care Center, Guwahati, India (PB, NB) and Department Anesthesiology and Pain Management, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA (AB).
Eur J Anaesthesiol. 2019 Jan;36(1):40-47. doi: 10.1097/EJA.0000000000000900.
Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications.
To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery.
Randomised, controlled and double-blind study.
The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014.
A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain.
Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery).
The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h.
In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported.
Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population.
唇腭裂是常见的颅面畸形，需要早期手术修复。这些患者术后发生气道阻塞和呼吸衰竭的风险较高。唇腭裂手术可能需要大剂量的阿片类药物，这可能导致这些并发症。
比较在上颌神经近、远侧阻滞在唇裂或腭裂手术中的效果。
随机、对照、双盲研究。
本研究于 2014 年 4 月至 6 月在印度阿萨姆邦的古瓦哈蒂进行。
纳入年龄大于 6 个月的 114 例接受唇裂或腭裂手术的患者。排除标准包括凝血障碍、周围神经病或慢性疼痛综合征、穿刺部位感染、局麻药过敏、缺乏同意、语言问题或其他可能妨碍术后疼痛评估的障碍。
患者随机分为两组：近侧组（双侧颧弓上眶下神经阻滞）和远侧组（唇裂修复双侧眶下神经阻滞和双侧腭大、小神经阻滞及鼻腭神经阻滞；腭裂手术）。
主要终点是需要额外阿片类药物剂量的患者比例。次要终点包括术后 24 小时内的疼痛评分、呼吸和神经阻滞相关并发症。
术中，近侧组纳布啡用量显著减少（9.1%比 25.4%，P=0.02）。近侧组需要术中芬太尼的患者比例较低（16.4%比 30.5%，P=0.07）。两组术后疼痛评分或术后并发症无差异。无技术失败或与阻滞相关的并发症。
在混合儿科和成人人群中，双侧颧弓上眶下神经阻滞是唇裂和腭裂手术中传统周围神经阻滞的有效且安全的替代方法。
