Impact of Suprazygomatic Maxillary Nerve Block on Opioid Use and Postoperative Outcomes in Syndromic and Non-Syndromic Children Undergoing Palatoplasty
Krystof Stanek*1, Lisa Nussbaum1, Walid Alrayashi2, Carolyn Rogers-Vizena1
1Plastic Surgery, Boston Children's Hospital, Boston, MA; 2Anesthesiology, Boston Children's Hospital, Boston, MA
While Suprazygomatic maxillary nerve block (SMB) reduces narcotic requirement in non-syndromic children undergoing palatoplasty, the degree to which this benefit extends to more medically complex syndromic children has not been evaluated. This study examines the impact of SMB on opioid use and postoperative outcomes in both the syndromic and non-syndromic cleft palate populations.
A retrospective review of children ≤24 months old who underwent palatoplasty by a single surgeon from September 2014 to September 2022 was conducted. Those undergoing additional procedures (gastrostomy, circumcision, etc.) were excluded. Collected data included demographics, syndrome, surgical details, and need for respiratory support. Opioid usage, calculated as morphine equivalent units (MEU/kg/hr), was assessed from 0-24 hours, 24-48 hours, and the entire postoperative period.
Among 87 patients, 50.5% received SMB. Median age was 10 months with no difference between SMB and non-SMB groups (p=0.7). Syndromic cleft palate constituted 44.8% of the sample, most commonly Robin sequence (71%) and CHARGE syndrome (7.7%). Narcotic need in the first 24 hours postoperatively (p=0.006) and the entire postoperative period (p=0.01) was reduced by more than half with SMB, even when adjusting for syndromic status. Subgroup analysis within the syndromic population confirmed reduced opioid requirement with SMB. No differences were found in need for postoperative respiratory support or ICU stay, and a trend of decreased hypoxemic episodes with SMB patients was not significant (p=0.09).
SMB is effective for managing postoperative pain in both syndromic and non-syndromic children undergoing palatoplasty. Prospective studies are needed to confirm these findings, better ellucidate whether the trend toward fewer hypoxemic episodes may represent a true benefit of SMB, and explore the impact of SMB on intraoperative management.
Back to 2023 Abstracts