Korean J Anesthesiol.  2018 Apr;71(2):135-140. 10.4097/kjae.2018.71.2.135.

Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study

• Mostafa MF
• Herdan R
• Elshazly M

• KMID: 2411221
• DOI: http://doi.org/10.4097/kjae.2018.71.2.135

Abstract

BACKGROUND
Cleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia.
METHODS
Sixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine.
RESULTS
Face, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications.
CONCLUSIONS
Levobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

Keyword

Bupivacaine; Cleft palate; Levobupivacaine; Maxillary nerve

MeSH Terms

Airway Obstruction
Analgesia
Analgesics, Opioid
Anesthesia, General
Anesthetics, Local
Bupivacaine*
Child
Cleft Lip
Cleft Palate*
Humans
Incidence
Leg
Maxillary Nerve*
Methods
Palate
Reading
Respiratory Insufficiency
Analgesics, Opioid
Anesthetics, Local
Bupivacaine