Ultrasound-guided suprazygomatic maxillary nerve blocks and perioperative opioid consumption in pediatric cleft palate repair: a retrospective cohort study

Effective opioid-sparing analgesia is essential in pediatric cleft palate repair, as infants and young children are vulnerable to opioid-related adverse effects. Ultrasound-guided suprazygomatic maxillary nerve (SZMN) blocks have emerged as a promising regional anesthesia technique, but evidence supporting their effectiveness remains limited. We conducted a retrospective observational cohort study of pediatric patients younger than 18 years who underwent cleft palate repair at a single tertiary academic medical center between January 2020 and February 2023. The primary outcome was total perioperative opioid consumption, measured as morphine milligram equivalents per kilogram (MME/kg). Secondary outcomes included intraoperative and postoperative opioid use, time to first successful feeding, and length of hospital stay. Multivariable linear regression was used to adjust for potential confounders, including cleft type and perioperative factors. Seventy-four patients met inclusion criteria, of whom 28 received an ultrasound-guided SZMN block. Patients who did not receive an SZMN block consumed more opioids (56%; 95% confidence interval [CI] 12.1–117.3; p = 0.010). After adjustment for cleft type and perioperative variables, absence of an SZMN block remained independently associated with higher opioid consumption (44.9%; 95% CI 3.39–103.2; p = 0.035). Reduction in intraoperative opioid use in the SZMN block group also reached statistical significance. No differences were observed in postoperative opioid use, time to first feeding, or hospital length of stay. Ultrasound-guided SZMN blocks were associated with reduced perioperative opioid consumption in pediatric cleft palate repair without prolonging recovery. Prospective studies are warranted to confirm these findings.