Asociacion PIEL.
Ricardo Gutierrez Children's Hospital.
J Craniofac Surg. 2020 Sep;31(6):1547-1550. doi: 10.1097/SCS.0000000000006633.
To introduce a different approach for maxillary nerve block (MNB), in cleft palate repair. To reduce the use of opioids during surgery and to prevent frequent respiratory complications by means of an adequate intra and postoperative pain relief.
A prospective clinical trial was planned, to collect scientific evidences between 2 groups of patients with primary cleft palate, receiving surgery in 2 Pediatric centers of Buenos Aires, utilizing a different protocol.Sixty patients undergoing primary cleft palate repair in both hospitals, from January 2017 to July 2018, by senior surgeons and the same expert anesthesiologists' team, were included.Syndromic and secondary cases, and patients whose parents rejected to participate of this study were excluded. The first group called Hospital A included 45 children, the second group identified as Hospital B was formed by 15 patients.A combination of general whit local anesthesia and a bilateral regional MNB, was used in all the patients of the Hospital A. Utilizing an aspirating syringe, children received 0.15 ml/kg of lidocaine clorhidrate 2% with epinephrine 1:50.000, under direct vision through the spheno palatine holes, just before surgery. A traditional general anesthesia procedure plus local anesthesia, was utilized in all the patients treated at the Hospital B Medial blood pressure and cardiac frequency parameters were tested during induction, along the surgical procedure and in the immediate post op, to detect any sign of pain (12). After surgery, patient reactivity, airway depression symptoms, time of initial feeding and discharge time, were also monitored (13).This study was approved by the Hospitals Ethics Committees of both hospitals, and is in accordance with the 1975 Helsinki Declaration, as amended in 1983. The parents have signed an informed consent form for all the patients included.
Patients of both groups did not show any significant variant in the monitored parameters to detect signals of pain, along the surgery. The rest of controls during and after surgery showed significant differences in favor of the patients of Hospital A.
Bilateral regional MNB, under direct vision trough the spheno palatine holes results an effective, easy, and safe method for pain relief during and after primary cleft palate repair surgeries.The combination of slight general anesthesia with local anesthesia and regional blocks, results a good option to reduce opioids utilization, to prevent neurotoxicity, respiratory depression, sickness, and vomiting facilitating early feeding and patient discharge.
介绍一种用于腭裂修复的上颌神经阻滞（MNB）的不同方法。通过充分的围手术期镇痛来减少手术期间阿片类药物的使用，并预防频繁的呼吸并发症。
计划进行一项前瞻性临床试验，以收集来自布宜诺斯艾利斯两家儿科中心的两组接受手术的原发性腭裂患者的科学证据，采用不同的方案。2017 年 1 月至 2018 年 7 月，由资深外科医生和同一专家麻醉师团队在这两家医院对 60 例接受原发性腭裂修复的患者进行了研究。排除综合征和继发性病例，以及拒绝参与本研究的患者。第一组称为 A 医院，包括 45 名儿童，第二组称为 B 医院，由 15 名患者组成。A 医院所有患者均采用全身麻醉联合局部麻醉和双侧区域性 MNB。使用带有肾上腺素 1:50000 的 2%利多卡因氯己定 0.15ml/kg，通过蝶腭孔直接可视下在手术前抽吸。B 医院所有患者均采用传统全身麻醉加局部麻醉。监测诱导、手术过程中和术后即刻的中动脉血压和心频率参数，以发现任何疼痛迹象（12）。手术后，还监测患者反应、气道抑制症状、首次进食时间和出院时间（13）。本研究得到了两家医院伦理委员会的批准，符合 1975 年赫尔辛基宣言，经 1983 年修订。所有纳入的患者的家长均签署了知情同意书。
两组患者在手术过程中监测的疼痛信号参数均无显著差异。手术中和手术后的其他监测结果显示，A 医院患者的差异有统计学意义。
通过蝶腭孔直接可视下进行双侧区域性 MNB 是一种有效、简便、安全的方法，可在原发性腭裂修复手术期间和之后缓解疼痛。将轻度全身麻醉与局部麻醉和区域阻滞相结合，是减少阿片类药物使用、预防神经毒性、呼吸抑制、恶心、呕吐、促进早期进食和患者出院的较好选择。
