University of Florida College of Medicine.
Department of Otolaryngology.
J Craniofac Surg. 2021;32(2):594-596. doi: 10.1097/SCS.0000000000006829.
Cleft palate is a common craniofacial malformation, requiring surgical repair in late infancy or early toddlerhood. Postoperative use of opioids is common to mitigate pain following palatoplasty. To decrease opioid consumption, improve postoperative pain, and decrease complications associated with general anesthetics, intraoperative regional nerve blocks have been employed for multimodal pain relief. While the literature supports intraoperative nerve block use for postprocedural comfort in children undergoing palatoplasty, the topic has not been systematically summarized.
The purpose of this review was to explore the efficacy of nerve block in palatoplasty, in addition to analyzing trends in nerve block modality and choice of local anesthetic on postoperative pain and opioid consumption.
A systematic literature search was conducted through PubMed, Embase, Cochrane, and Web of Science databases for studies on cleft palate nerve block. Resulting reference lists were searched for potential eligible studies and then reviewed, with an emphasis on pain scores, postoperative analgesia consumption, and time to analgesia use.
A total of 259 articles were reviewed, of which 10 met inclusion criteria. Intraoperative suprazygomatic and greater palatine nerve blocks were the 2 most commonly reported blocks. Long acting agents, such as bupivacaine and ropivacaine, were the local anesthetic of choice. All modalities were effective in reducing postoperative pain scores and opioid consumption.
Intraoperative nerve blocks have been shown to be incredibly effective in reducing postoperative pain in children undergoing palatoplasty, minimizing both opioid consumption and recovery time. The existing literature suggests that suprazygomatic block with combined bupivacaine and dexmedetomidine is the preferred nerve block modality. Ultrasound guidance should be used when accessible.Level of Evidence: 2.
腭裂是一种常见的颅面畸形，需要在婴儿后期或幼儿早期进行手术修复。术后使用阿片类药物是缓解腭裂修复术后疼痛的常见方法。为了减少阿片类药物的使用、改善术后疼痛并减少与全身麻醉相关的并发症，术中区域神经阻滞已被用于多模式止痛。虽然文献支持在腭裂修复术中使用神经阻滞来缓解术后舒适度，但这一主题尚未得到系统总结。
本综述的目的是探讨神经阻滞在腭裂修复术中的疗效，并分析神经阻滞方式和局部麻醉药选择对术后疼痛和阿片类药物消耗的趋势。
通过 PubMed、Embase、Cochrane 和 Web of Science 数据库对腭裂神经阻滞的研究进行了系统的文献检索。对检索到的参考文献列表进行了进一步的搜索，以寻找可能符合条件的研究，并对其进行了回顾，重点关注疼痛评分、术后镇痛消耗和使用镇痛时间。
共回顾了 259 篇文章，其中 10 篇符合纳入标准。术中眶上神经和腭大神经阻滞是最常报道的两种阻滞方法。长效药物如布比卡因和罗哌卡因是首选的局部麻醉剂。所有方法均能有效降低术后疼痛评分和阿片类药物消耗。
术中神经阻滞已被证明可非常有效地减轻腭裂患儿术后疼痛，最大限度地减少阿片类药物的消耗和恢复时间。现有文献表明，眶上神经阻滞联合布比卡因和右美托咪定是首选的神经阻滞方式。在可行的情况下，应使用超声引导。
2 级
