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Original Article

The Korean Journal of Pain 2020; 33(1): 81-89

Published online January 1, 2020 https://doi.org/10.3344/kjp.2020.33.1.81

Copyright © The Korean Pain Society.

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

Mohamed F. Mostafa1 , Fatma A. Abdel Aal1 , Ibrahim Hassan Ali1 , Ahmed K. Ibrahim2 , and Ragaa Herdan1

1Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
2Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt

Correspondence to:Mohamed F. Mostafa
Department of Anesthesia and Intensive Care, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Tel: +20-1001123062
Fax: +20-88-2333327
E-mail: mo7_fathy@yahoo.com

Received: July 26, 2019; Revised: December 3, 2019; Accepted: December 3, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Analgesia, Bupivacaine, Child, Cleft Palate, Dexmedetomidine, Maxillary Nerve, Nerve Block, Pain, Postoperative