Suprazygomatic infratemporal pterygopalatine fossa block with adjuvant low-dose dexmedetomidine for adenotonsillectomy

Zoghbi, Veronica; Pan, Stephanie; Lin, Carole; Balakrishnan, Karthik; Tsui, Ban C. H.

doi:10.1007/s12630-022-02190-8

Cited by 1 publication

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The adenotonsillar tissues receive innervation from both the glossopharyngeal nerve and the lesser palatine branch of the maxillary nerve, creating a complex neural network . Thus, regional anesthesia had seldom been used in this surgical population until recently . The suprazygomatic maxillary nerve block (also known as maxillary nerve, pterygopalatine, and infratemporal fossa block) can be administered as a local anesthetic to block the maxillary nerves and decrease sensation to various oral structures, including the tonsils, uvula, adenoids, and soft palate .…”

Section: Introductionmentioning

confidence: 99%

“…28 Thus, regional anesthesia had seldom been used in this surgical population until recently. [29][30][31][32] The suprazygomatic maxillary nerve block (also known as maxillary nerve, pterygopalatine, and infratemporal fossa block) can be administered as a local anesthetic to block the maxillary nerves [33][34][35] and decrease sensation to various oral structures, including the tonsils, uvula, adenoids, and soft palate. 36 This technique selectively anesthetizes the posterior pharynx while preserving vital protective airway reflexes, such as coughing and swallowing, by sparing the glossopharyngeal nerve.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Suprazygomatic Maxillary Nerve Blocks and Opioid Requirements in Pediatric Adenotonsillectomy

Lin,

Abboud,

Zoghbi

et al. 2024

JAMA Otolaryngol Head Neck Surg

Self Cite

View full text Add to dashboard Cite

ImportancePain management following pediatric adenotonsillectomies is opioid-inclusive, leading to potential complications.ObjectiveTo investigate the use of suprazygomatic maxillary nerve (SZMN) blocks to reduce pain and opioid use after pediatric intracapsular adenotonsillectomy and to measure recovery duration and incidence of complications.Design, Setting, and ParticipantsThis was a randomized, blinded, prospective single-center tertiary pediatric hospital that included 60 pediatric patients (2-14 years old) scheduled for intracapsular adenotonsillectomy from November 2021 to March 2023. Patients were excluded for having combined surgical procedures, developmental delay, coagulopathy, chronic pain history, known or predicted difficult airway, or unrepaired congenital heart disease. Participants were randomized to receive bilateral SZMN blocks (block group) or not (control group).InterventionSZMN block administered bilaterally under general anesthesia for intracapsular adenotonsillectomy.Primary Outcomes and MeasuresOpioid consumption, FLACC (Face, Legs, Activity, Cry, Consolability) scores, and rates of opioid-free postanesthesia care unit (PACU) stay. Secondary outcomes were recovery duration and incidence of adverse effects, ie, nausea, vomiting, block site bleeding, and emergency delirium.ResultsThe study population included 53 pediatric patients (mean [SD] age, 6.5 [3.6] years; 29 [55%] females; 24 [45%] males); 26 were randomly assigned to the SZMN block group and 27 to the control group. The mean (SD) opioid morphine equivalent consumption during PACU stay was 0.15 (0.14) mg/kg for the 27 patients in the control group compared with 0.07 (0.11) mg/kg for the 26 patients in the block group (mean difference, 0.08; 95% CI, 0.01-0.15; Cohen d, 0.64). The block group had a higher incidence of opioid-free PACU stays (n = 7 patients; 58%) compared with the control group (n = 15 patients; 26%) (mean difference, 32%; 95% CI, 5%-53%). Patients in the block group experienced lower FLACC scores (0.7 vs 1.6; mean difference, 0.9; 95% CI, 0.2-1.6; Cohen d, 0.7). The overall occurrence of adverse events was similar in the 2 groups, with no reported nerve block-related complications.Conclusions and RelevanceThe results of the randomized clinical trial indicate that SZMN blocks are a useful adjunct tool for managing postoperative pain in pediatric intracapsular adenotonsillectomy. Use of these blocks during adenotonsillectomy provided clinically meaningful reductions of postoperative opioid consumption with a low risk of complications.Trial RegistrationClinicalTrials.gov Identifier: NCT04797559

show abstract

Section: Introductionmentioning

confidence: 99%