Key result
Dexmedetomidine plus bupivacaine prolongs analgesia by ~7 hours vs bupivacaine alone in cleft palate repair.
Why the study?
Cleft palate repair causes severe pain and sympathetic stimulation, necessitating evaluation of analgesic efficacy of bupivacaine alone versus bupivacaine with dexmedetomidine in bilateral suprazygomatic maxillary nerve block.
Does adding dexmedetomidine to bupivacaine in bilateral suprazygomatic maxillary nerve block improve postoperative analgesia in pediatric patients undergoing cleft palate repair?
RCT (n=46)
Double-blind
Computer generated block randomization
No
Does adding dexmedetomidine to bupivacaine in bilateral suprazygomatic maxillary nerve block improve postoperative analgesia in pediatric patients undergoing cleft palate repair?
Adding dexmedetomidine to bupivacaine for bilateral suprazygomatic maxillary nerve blocks significantly prolongs analgesia and reduces postoperative pain in children undergoing cleft palate repair.
Adding dexmedetomidine to bupivacaine prolongs analgesia and lowers pain scores after cleft palate repair; extends RCT support for its use as SMN block adjuvant.
Objective: Cleft palate repair involves surgery on the both hard and soft palate leading to severe pain, intense sympathetic stimulation, and bleeding. In our study we analysed the analgesic efficacy of bupivacaine alone and bupivacaine with dexmedetomidine in ultrasound guided bilateral suprazygomatic maxillary nerve block (SMN) for cleft palate repair. Methods: This study was a randomized prospective double-blinded study. Fourty six children of the ASA class I and II posted for cleft palate repair were randomized into Group A and Group B. In Group A, 23 children had SMN block with 0.15 mL kg-1 of 0.25% bupivacaine with saline and the same procedure was repeated on other side. In Group B, 23 children received SMN block with a volume of 0.15 mL kg-1 of 0.25% bupivacaine with dexmedetomidine 0.5 µg kg-1 on each side. Primary outcomes analysed were pain scores in post operative period by Children and Infants Post-Operative Pain Scale (CHIPPS) and the analgesia duration. Postoperative pain scores were analysed at 30 minutes intervals for 2 hours in Post Anaesthesia Care Unit (PACU) and at every 2 hours interval for 24 hours in the postoperative ward. Results: Group A and B were comparable in demographic variables like age, gender, weight, ASA status, and duration of surgery. Children in Group B had significantly longer duration of analgesia when compared to that of Group A (12±4.73 hours vs 5.41± 3.9 hours) (p=0.003). Children had significantly lower pain scores in Group B at zero min in PACU (p=0.04), after 90 min (p=0.02), at 2 hours (p<0.001), 4 hours (p<0.001), 6 hours (p=0.006) and at 8 hours (p=0.02) when compared to that in Group A. Conclusion: Children who received bupivacaine with dexmedetomidine in SMN block had a longer analgesia duration and lesser postoperative pain scores than children who received bupivacaine alone.
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Ramasamy et al. (2022) conducted an RCT in Cleft palate (n=46). Bupivacaine with dexmedetomidine vs. 0.15 mL/kg of 0.25% bupivacaine with saline on each side was evaluated on Duration of analgesia (hours) (p=0.003). Dexmedetomidine added to bupivacaine in bilateral suprazygomatic maxillary nerve block significantly prolonged analgesia duration (12 vs 5.41 hours) and reduced postoperative pain scores compared to bupivacaine alone in children undergoing cleft palate repair.
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