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

Mohamed F Mostafa, Fatma A Abdel Aal, Ibrahim Hassan Ali, Ahmed K Ibrahim, Ragaa Herdan, Mohamed F Mostafa, Fatma A Abdel Aal, Ibrahim Hassan Ali, Ahmed K Ibrahim, Ragaa Herdan

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.

Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Suprazygomatic maxillary nerve block landmarks.
Fig. 2
Fig. 2
CONSORT flow diagram of the two studied groups. 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).
Fig. 3
Fig. 3
Changes in heart rate (HR) in the two studied groups. 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). PO: postoperative. *P < 0.05.
Fig. 4
Fig. 4
Changes in mean arterial blood pressure (MAP) in the two studied groups. 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). PO: postoperative. *P < 0.05. ***P < 0.001.

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