The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

  • Mostafa, Mohamed F. (Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University) ;
  • Aal, Fatma A. Abdel (Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University) ;
  • Ali, Ibrahim Hassan (Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University) ;
  • Ibrahim, Ahmed K. (Department of Public Health, Faculty of Medicine, Assiut University) ;
  • Herdan, Ragaa (Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University)
  • Received : 2019.07.26
  • Accepted : 2019.12.03
  • Published : 2020.01.01
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Abstract

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 ㎍/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 ㎍/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.

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References

  1. Liau JY, Sadove AM, van Aalst JA. An evidence-based approach to cleft palate repair. Plast Reconstr Surg 2010; 126: 2216-21. https://doi.org/10.1097/PRS.0b013e3181f830eb
  2. Takemura H, Yasumoto K, Toi T, Hosoyamada A. Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate. Paediatr Anaesth 2002; 12: 585-8. https://doi.org/10.1046/j.1460-9592.2002.00906.x
  3. Chiono J, Raux O, Bringuier S, Sola C, Bigorre M, Capdevila X, et al. Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children: a prospective, randomized, double-blind study versus placebo. Anesthesiology 2014; 120: 1362-9. https://doi.org/10.1097/ALN.0000000000000171
  4. Bosenberg A. Benefits of regional anesthesia in children. Paediatr Anaesth 2012; 22: 10-8. https://doi.org/10.1111/j.1460-9592.2011.03691.x
  5. Morton NS, Errera A. APA national audit of pediatric opioid infusions. Paediatr Anaesth 2010; 20: 119-25. https://doi.org/10.1111/j.1460-9592.2009.03187.x
  6. Singh B, Srivastava SK, Dang R. Anatomic considerations in relation to the maxillary nerve block. Reg Anesth Pain Med 2001; 26: 507-11. https://doi.org/10.1053/rapm.2001.26218
  7. Captier G, Dadure C, Leboucq N, Sagintaah M, Canaud N. Anatomic study using three-dimensional computed tomographic scan measurement for truncal maxillary nerve blocks via the suprazygomatic route in infants. J Craniofac Surg 2009; 20: 224-8. https://doi.org/10.1097/SCS.0b013e318191d067
  8. Mesnil M, Dadure C, Captier G, Raux O, Rochette A, Canaud N, et al. A new approach for peri-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block. Paediatr Anaesth 2010; 20: 343-9. https://doi.org/10.1111/j.1460-9592.2010.03262.x
  9. Prigge L, van Schoor AN, Bosman MC, Bosenberg AT. Clinical anatomy of the maxillary nerve block in pediatric patients. Paediatr Anaesth 2014; 24: 1120-6. https://doi.org/10.1111/pan.12480
  10. Lee MJ, Koo DJ, Choi YS, Lee KC, Kim HY. Dexamethasone or dexmedetomidine as local anesthetic adjuvants for ultrasound-guided axillary brachial plexus blocks with nerve stimulation. Korean J Pain 2016; 29: 29-33. https://doi.org/10.3344/kjp.2016.29.1.29
  11. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth 2010; 104: 538-46. https://doi.org/10.1093/bja/aeq069
  12. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175-91. https://doi.org/10.3758/BF03193146
  13. Splinter WM, Semelhago LC, Chou S. The reliability and validity of a modified CHEOPS pain score. Anesth Analg 1994; 78: S413.
  14. Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesth Analg 2001; 92: 199-204.
  15. Jamieson S. Likert scales: how to (ab)use them. Med Educ 2004; 38: 1217-8. https://doi.org/10.1111/j.1365-2929.2004.02012.x
  16. Kulkarni KR, Patil MR, Shirke AM, Jadhav SB. Perioperative respiratory complications in cleft lip and palate repairs: an audit of 1000 cases under 'Smile Train Project'. Indian J An aesth 2013; 57: 562-8. https://doi.org/10.4103/0019-5049.123328
  17. Law RC, de Klerk C. Anaesthesia for cleft lip and palate surgery. Updates in Anesthesia 2002; 14: 27-30.
  18. Desalu I, Adeyemo W, Akintimoye M, Adepoju A. Airway and respiratory complications in children undergoing cleft lip and palate repair. Ghana Med J 2010; 44: 16-20.
  19. Reena, Bandyopadhyay KH, Paul A. Postoperative analgesia for cleft lip and palate repair in children. J Anaesthesiol Clin Pharmacol 2016; 32: 5-11. https://doi.org/10.4103/0970-9185.175649
  20. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 2013; 110: 915-25. https://doi.org/10.1093/bja/aet066
  21. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59: 263-8. https://doi.org/10.2165/00003495-200059020-00012
  22. Almarakbi WA, Kaki AM. Addition of dexmedetomidine to bupivacaine in transversus abdominis plane block potentiates post-operative pain relief among abdominal hysterectomy patients: a prospective randomized controlled trial. Saudi J Anaesth 2014; 8: 161-6. https://doi.org/10.4103/1658-354x.130683
  23. Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and metaanalysis of randomized controlled trials. Br J Anaesth 2017; 118: 167-81. https://doi.org/10.1093/bja/aew411
  24. Song JH, Shim HY, Lee TJ, Jung JK, Cha YD, Lee DI, et al. Comparison of dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in brachial plexus block. Korean J Anesthesiol 2014; 66: 283-9. https://doi.org/10.4097/kjae.2014.66.4.283
  25. Jonnavithula N, Durga P, Madduri V, Ramachandran G, Nuvvula R, Srikanth R, et al. Efficacy of palatal block for analgesia following palatoplasty in children with cleft palate. Paediatr Anaesth 2010; 20: 727-33. https://doi.org/10.1111/j.1460-9592.2010.03347.x
  26. Sola C, Raux O, Savath L, Macq C, Capdevila X, Dadure C. Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: a descriptive prospective study. Paediatr Anaesth 2012; 22: 841-6. https://doi.org/10.1111/j.1460-9592.2012.03861.x
  27. Kamath MR, Mehandale SG, Us R. Comparative study of greater palatine nerve block and intravenous pethidine for postoperative analgesia in children undergoing palatoplasty. Indian J Anaesth 2009; 53: 654-61.
  28. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol 2010; 27: 280-4. https://doi.org/10.1097/EJA.0b013e3283347c15
  29. Mostafa MF, Herdan R, Elshazly M. Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study. Korean J Anesthesiol 2018; 71: 135-40. https://doi.org/10.4097/kjae.2018.71.2.135
  30. Ahmed SA, Elmawy MG, Magdy AA. Effect of the use of dexmedetomidine as an adjuvant in peribulbar anesthesia in patients presented for vitreoretinal surgeries. Egypt J Anaesth 2018; 34: 27-32. https://doi.org/10.1016/j.egja.2017.10.001
  31. Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries. Indian J Anaesth 2011; 55: 340-6. https://doi.org/10.4103/0019-5049.84835
  32. Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, et al. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and metaanalysis. PLoS One 2014; 9: e93114. https://doi.org/10.1371/journal.pone.0093114
  33. Fritsch G, Danninger T, Allerberger K, Tsodikov A, Felder TK, Kapeller M, et al. Dexmedetomidine added to ropivacaine extends the duration of interscalene brachial plexus blocks for elective shoulder surgery when compared with ropivacaine alone: a single-center, prospective, triple-blind, randomized controlled trial. Reg Anesth Pain Med 2014; 39: 37-47. https://doi.org/10.1097/AAP.0000000000000033
  34. Kim KH. Safe sedation and hypnosis using dexmedetomidine for minimally invasive spine surgery in a prone position. Korean J Pain 2014; 27: 313-20. https://doi.org/10.3344/kjp.2014.27.4.313

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