Ultrasound-guided suprazygomatic maxillary nerve block in cleft palate surgery: The efficacy of adding dexmedetomidine to bupivacaine

Figures & data

Figure 1. (A) Anatomical landmark of suprazygomatic maxillary nerve block. (B) The entry point of the needle is located at the frontozygomatic angle bounded by superior edge of the zygomatic arch below and posterior orbital edge forward. (C) Ultrasound images describe suprazygomatic maxillary nerve block; anatomy of PPF (pterygopalatine fossa) and TMM (tempromaxillary muscle) with guidance of Doppler flow (red color) to localize neurovascular bundle. (D) Local anesthetic (LA) spread in PPF

Table 1. Demographic characteristics and duration of surgery of both studied groups

	Group B (n = 40)	Group BD (40)	P – value
Age (months)	11.5 ± 3.9	10.8 ± 4.2	0.297
Sex (M) (F)	24 (60%) 16 (40%)	22 (55%) 18 (45%)	0.651
Weight (kg)	9.6 ± 1.3	9.1 ± 1.2	0.067
Duration of surgery (min)	100.5 ± 13.9	99.3 ± 14.9	0.694

Data expressed as Mean ± SD or patient number (%).

Group B = bupivacaine only; Group BD = bupivacaine plus dexmedetomidine

P < 0.05 was considered significant.

Figure 2. CONSORT flow diagram of the participants through each stage of the randomized trial. Group B = bupivacaine only; group BD = bupivacaine plus dexmedetomidine

Table 2. Perioperative rescue of analgesia and time to feed of both studied group

			Group B (n = 40)	Group BD (n = 40)	P- value
Perioperative rescue of analgesia	-Intraoperative fentanyl requirements	(µg/kg)	1.85 ± 3.786	1.28 ± 3.097	0.490
		(number)	8 (20%)	6 (15%)	0.428
	-Total nalbuphine doses	(mg)	2.1 ± 1.8	0.3 ± 0.7	< 0.001*
		(number)	26 (65%)	7 (17.5%)	< 0.001*
Time to feed (h)			4 (3–4.5)	4 (3–5)	0.376

Data expressed as Mean ± SD, patient number (%) or median (interquartile range).

Group B = bupivacaine only; Group BD = bupivacaine plus dexmedetomidine

P < 0.05 was considered significant.

Figure 3. Box plots of CHHIPS score during first 24 h postoperatively in the two studied groups. Group B = bupivacaine only; group BD = bupivacaine plus dexmedetomidine

Figure 4. Kaplan-Meier survival curve represents the first time of rescue analgesia in the two studied groups. Group B = bupivacaine only; group BD = bupivacaine plus dexmedetomidine

Table 3. Sedation and complications of both studied group

		Group B (n = 40)	Group BD (n = 40)	P- value
Sedation	-PACU	2 (1–2)	2 (1–3)	0.037٭
	−2 H	1 (1–1)	1 (1–1.75)	0.595
	−4 H	1 (1–1)	1 (1–1)	0.079
Complications	-Hypotension	0 (0%)	2 (5%)	0.494
	-Bradycardia	3 (7.5%)	8 (20%)	0.105
	-PONV	3 (7.5%)	1 (2.5%)	0.615

Data expressed as patient number (%) or median (interquartile range).

Group B = bupivacaine only; Group BD = bupivacaine plus dexmedetomidine

P < 0.05 was considered significant.