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Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. In every patient, the surgeon infiltrated the lip with 4-7 ml of 1% lidocaine with 1:100,000 epinephrine for both anesthesia and hemostasis. Post-operative evaluations were completed after 4, 8, and 12 to 24 hours and were based on a visual analogue scale for pain. Similarly, the nurses and the parents also evaluated post-operative discomfort using specific criteria. All the observers were kept unaware of the solutions used for the block. The results showed that Group A was pain free for a mean duration of 19.4 +/- 5.06 (SD) hours in contrast to 11.7 +/- 6.19 hours for Group B, (p less than 0.001). Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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After tonsillectomy and adenoidectomy procedures, despite reduced postoperative vomiting with use of propofol rather than halothane, along with nitrous oxide for anesthetic maintenance, the authors found no differences in "true" endpoints such as unplanned admissions or discharge times. Among the groups, the main factor that delayed hospital discharge beyond 6 h was vomiting within the first 6 h.

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