Feeding following cleft palate surgery: a prospective randomized clinical trial comparing suprazygomatic maxillary nerve block and greater palatine nerve block

INTRODUCTION: In the context of cleft-lip and palate surgery, both suprazygomatic maxillary nerve blocks (SZMNB) and greater palatine nerve blocks (GPNB) have been shown to provide improved postoperative pain relief. In this context, both pain relief and early postoperative feeding are of great importance. However, these two techniques have so far not been properly compared with regard to these characteristics. METHODS: Children 1-10 years of age undergoing palate surgery were randomized to either SZMNB or GPNB. Primary aim was early (0-24 hour) postoperative feeding (%) in relation to full normal oral feeding. Secondary aims were postoperative pain scores and need for rescue paracetamol administration (pain score >4). RESULTS: 30 patients were randomized to each study group (no missing data). Patients in group SZMNB displayed significantly better oral feeding during the first 24 hours compared with the GPNB group (median 80% [range 70-90%] and median 60% [range 40-70], respectively; p<0.00001). Group SZMNB did also show lower pain scores during 0-12 hour postoperatively (p<0.05-0.001) and fewer patients needed rescue paracetamol (p<0.05) compared with the GPNB group. CONCLUSION: The use of bilateral suprazygomatic maxillary nerve blocks was found superior to greater palatine blocks with regard to the amount of postoperative feeding in children undergoing palate surgery. Bilateral suprazygomatic maxillary nerve blocks were also associated with lower postoperative pain scores during the first 12 hours postoperative, further reflected by the reduced need for postoperative rescue administration of intravenous paracetamol.