title: Bilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children.
abstract: Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. In every patient, the surgeon infiltrated the lip with 4-7 ml of 1% lidocaine with 1:100,000 epinephrine for both anesthesia and hemostasis. Post-operative evaluations were completed after 4, 8, and 12 to 24 hours and were based on a visual analogue scale for pain. Similarly, the nurses and the parents also evaluated post-operative discomfort using specific criteria. All the observers were kept unaware of the solutions used for the block. The results showed that Group A was pain free for a mean duration of 19.4 +/- 5.06 (SD) hours in contrast to 11.7 +/- 6.19 hours for Group B, (p less than 0.001). Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anesthesia, Georgetown University Medical Center, Washington, D.C.
authors.forename: H F
authors.initials: HF
authors.lastname: Nicodemus
authors.forename: M J
authors.initials: MJ
authors.lastname: Ferrer
authors.forename: V C
authors.initials: VC
authors.lastname: Cristobal
authors.forename: L
authors.initials: L
authors.lastname: de Castro
mesh_terms: D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008442:Maxillary Nerve; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D002045:Bupivacaine