Postoperative pain score, Faces, Legs, Activity, Cry, Consolability (FLACC) is the primary
      outcome. The secondary outcomes are the first-time requested analgesia, the number of
      children required analgesia, the total amount of analgesic requirements during first the 24
      hours.

Dexamethasone as Adjuvant to Bupivacaine in Suprazygomatic Maxillary Nerve Block

Nerve Block

Congenital cleft palate (CP) occurs in children at a rate of about 1.5 per 10 000 births ,
      requiring early surgery, during the first months of life. The surgical procedure can be
      complicated by airway obstruction and respiratory complications. CP is painful in the first
      24-48 hours following surgery.

      Different treatment modalities have been used for reducing or ameliorating the pain following
      cleft palate repair. These include opioids, paracetamol, non steroidal anti-inflammatory
      drugs (NSAIDs). However, the analgesic drugs may provide inadequate analgesia and have side
      effects such as respiratory depression and bleeding. The inherent disadvantages of analgesic
      pharmacotherapy in children promoted interest in nerve blocking techniques for operative
      analgesia.

      The maxillary nerve, the second division of the trigeminal nerve, leaves the cranial part of
      the face through the foramen rotundum, and then passes forward and laterally through the
      pterygopalatine fossa, at the bottom of the pterygomaxillary fossa, and reaches the floor of
      the orbit by the infra-orbital foramen. This sensory nerve supplies innervation of the lower
      eyelid, the upper lip, the skin between them, the roof of the mouth, and the palate.
      Bilateral infra-orbital nerve block is clearly inefficient for anesthesia of the posterior
      part of the palate (hard palate). The infrazygomatic route of the maxillary block, useful for
      trigeminal neuralgia, can present several risks such as penetration of the orbit or the skull
      and accidental maxillary artery puncture. The palatine nerve block could be efficient for
      analgesia following cleft palate repair, but the technique requires identifying the first
      molar, which is absent in infants. Finally, submucosal infiltration performed by the surgeon
      seems to alter surgical conditions. Maxillary nerve block using the suprazygomatic approach
      has demonstrated beneficial effects in adults for trigeminal neuralgia and limits the risks
      related to the procedure.

Dexamethasone

Bupivacaine

Comparative Study Between Dexamethasone Plus Bupivacaine Versus Bupivacaine in Management of Suprazygomatic Maxillary Nerve Block in Cleft Palate Patients.

pain in Faces, Legs, Activity, Cry, Consolability (FLACC) Each category is scored on the 0-2 scale which results in a total score of 0-10.

0 = Relaxed and comfortable 1-3 = Mild discomfort 4-6 = Moderate pain 7-10 = Severe discomfort/pain

Anaesthesia and ICU Resident

The number of children required analgesia.

The total amount of analgesic requirements .

bilateral suprazygomatic maxillary nerve block will be performed with 1 mL of 0.5% bupivacaine was added to 0.1 mg.kg-1 dexamethasone and diluted to 2 mL with 0.9% saline.

bilateral suprazygomatic maxillary nerve block will be performed with 1 mL of 0.5% bupivacaine alone and diluted to 2 mL with 0.9% saline.

Dexamethasone as Adjuvant to Bupivacaine in Suprazygomatic Maxillary Nerve Block

About this trial

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Placebo

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