Bilateral Extraoral, Infraorbital Nerve Block for Postoperative Pain Relief After Cleft Lip Repair in Pediatric Patients

Abstract

The objective of this study was to evaluate the effectiveness of bilateral extraoral infraorbital nerve block with 0.25% bupivacaine administered at the end of surgery in postoperative pain relief after cleft lip repair. Forty ASA I-II children were randomly divided into 2 groups. Group I received 1.5 mL 0.25% bupivacaine and group II received 1.5 mL saline. FLACC scores of the patients in the recovery room in group I were 4 times less than in group II (P = 0.001) and in the first 4 hours postoperatively were apparently less in group I (P = 0.001). Mean time to first paracetamol requirement was longer in group I (P = 0.001). Total paracetamol consumption was lower in group I (P = 0.001). None of the patients required rescue tramadol in group I, whereas all patients in group II needed. In group I, parent satisfaction scores were higher (P = 0.001). Vomiting incidence was higher in group II (P = 0.028). Bilateral extraoral, infraorbital nerve block administered at the end of surgery provides satisfactory analgesia with high parental satisfaction and lower complication rates and reduces rescue analgesic consumption in patients undergoing repair of cleft lip.

The effect of infraorbital nerve block on emergence agitation in children undergoing cleft lip surgery under general anesthesia with sevoflurane

“…Although EA can occur when pain was relieved adequately (12) or even following nonpainful procedures (imaging) (13), effective analgesia with regional blockade, opioids, and nonsteroidal anti-inflammatory drugs can prevent and treat EA in children (14)(15)(16). According to recent reports, infraorbital nerve block provided satisfactory analgesia with lower complication rates and reduced rescue analgesic need in patients undergoing repair of cleft lip (7)(8)(9). Similarly, our results also identified better postoperative pain relief and lower analgesic consumption without increased side effects in patients who had an infraorbital nerve block.…”

“…The endtidal concentration of sevoflurane in Group B was lower than that in Group S. The incidence of EA was 16% in Group B and 42% in Group S (P = 0.008). The PAED scale score in Group B (mean [95% CI] 9 [8][9][10][11][12]) was lower than that in ). The duration of EA in Group B was shorter than that in Group S. CHIPPS score in postanesthetic care unit were lower in Group B (mean [95% CI] 3 [2-3.3]) compared with that in ).…”

Perioperative respiratory complications in cleft lip and palate repairs: An audit of 1000 cases under ′Smile Train Project′

“…[20] Incidence of post-operative bleeding was 4.3% in old literature,[15] which has come down to 0.5% in recent studies due to improved techniques and use of cauterisation. [21] The incidence of palatal fistula formation is reported to be 6 %.…”

Protocols in Cleft Lip and Palate Treatment: Systematic Review

“…On the comparison of bilateral nerve block with bupivacaine versus plain saline, there were one article approaching palatal block [38] and two approaching infraorbital nerve block [39, 40]. Prabhu et al proved with a randomized, double blind, prospective clinical trial that bilateral infraorbital nerve block with bupivacaine is more effective than peri-incisional infiltration in postoperative pain relief after cleft lip repair [71], and it became a standard clinical practice in cleft care [72, 73].…”