Effectiveness of suprazygomatic maxillary nerve block on postoperative opioid use in pediatric primary cleft palate surgery: A systematic review of the literature

Abstract

Objective: To evaluate the efficacy of preoperative suprazygomatic maxillary nerve block (SMNB) in reducing opioid consumption and improving recovery outcomes in pediatric cleft palate surgery.

Design: Systematic review with narrative synthesis due to methodological heterogeneity.

Setting: Institutional settings performing pediatric cleft palate surgery.

Patients, participants: Fifteen studies met inclusion criteria, assessing pediatric patients undergoing cleft palate repair with SMNB compared to control conditions.

Interventions: Preoperative SMNB performed using various local anesthetics, including bupivacaine (alone or with dexmedetomidine), ropivacaine, and levobupivacaine.

Main outcome measure(s): Primary outcome was postoperative opioid consumption. Secondary outcomes included time to oral feeding and length of hospital stay.

Results: Among the 15 included studies, 13 demonstrated a reduction in postoperative opioid consumption following SMNB. Of these, 10 met the criteria for clinical significance, defined as ≥1.5-fold higher opioid use in the control group, and 5 showed statistically significant differences. Of 7 studies assessing time to oral feeding, 3 reported ≥4 h reductions in SMNB patients. One of the 4 studies assessing hospital stay showed a significant reduction of approximately 1 day. Methodological heterogeneity and bias due to confounding or subjective assessments were noted in 3 studies, limiting meta-analysis.

Conclusion: Suprazygomatic maxillary nerve block effectively reduces postoperative opioid use and improves recovery outcomes in pediatric cleft palate surgery, particularly when combined with adjuncts like dexmedetomidine. However, while SMNB is an effective regional anesthesia technique, current evidence does not conclusively demonstrate superiority over other nerve blocks or local infiltration. Further research with standardized protocols and consensus methods is required to clarify its relative benefits.

Keywords: Cleft palate; Opioid reduction; Palatoplasty; Pediatric anesthesia; Postoperative pain management; Suprazygomatic maxillary nerve block.