Background: For children with cleft palates, surgeries at a young age are necessary
to reduce feeding or phonation difficulties and reduce complications, especially
respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine
might prolong the postoperative analgesic duration when added to bupivacaine
during nerve blocks.
Methods: Eighty patients of 1-5 years old were arbitrarily assigned to two equal
groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve
blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume
4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5
µg/kg dexmedetomidine (maximum volume 4 mL/side).
Results: The modified children’s hospital of Eastern Ontario pain scale score was
significantly lower in group B children after 8 hours of follow-up postoperatively (P <
0.001). Mean values of heart rate and blood pressure were significantly different
between the groups, with lower mean values in group B (P < 0.001). Median time
to the first analgesic demand in group A children was 10 hours (range 8-12 hr),
and no patients needed analgesia in group B. The sedation score assessment was
higher in children given dexmedetomidine (P = 0.03) during the first postoperative
30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in
group B and without serious adverse effects.
Conclusions: Addition of dexmedetomidine 0.5 μg/kg to bupivacaine 0.125% has
accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve
block in children undergoing primary cleft palate repair with less postoperative
supplemental analgesia or untoward effects.