title: Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: a descriptive prospective study.
abstract: BACKGROUND
  Bilateral suprazygomatic maxillary nerve blocks approach improves pain relief after palate surgery. We report the feasibility and efficiency of ultrasound-guided suprazygomatic maxillary nerve blocks in cleft palate repair in children.
  
  
  METHODS
  Twenty-five children scheduled to undergo surgical cleft palate repair were included. Ultrasound-guided suprazygomatic maxillary blocks were performed according to landmarks previously defined. The ultrasound probe was located optimally over the maxilla and under the zygomatic bone to visualize the pterygopalatine fossa. 0.15·ml·kg(-1) of 0.2% ropivacaine was injected bilaterally. Feasibility of block, spread of local anesthetic, pain scores and side effects were noted.
  
  
  RESULTS
  Fifty ultrasound-guided suprazygomatic maxillary nerve blocks were performed in 25 children. The needle movement was seen in all cases using an out-of-plane approach. The spread of LA was clearly observed in 94% (47/50) of cases. A poor ultrasound imaging was found in 4% (2/50), and the spread of LA was not identified in 2% of case (1/50). The median time to perform the block was 56 s (35-120 s). The median pain scores and consumption of nalbuphine were low during the study period. 80% of patients did not require continuous opioid infusion. No complication related to maxillary blocks was reported.
  
  
  CONCLUSIONS
  With a very low technical failure rate and a good clinical success rate, ultrasound appears to be a useful and simple tool to aid suprazygomatic maxillary nerve block in children.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Chrystelle
authors.initials: C
authors.lastname: Sola
authors.forename: Olivier
authors.initials: O
authors.lastname: Raux
authors.forename: Laurent
authors.initials: L
authors.lastname: Savath
authors.forename: Christine
authors.initials: C
authors.lastname: Macq
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
authors.forename: Christophe
authors.initials: C
authors.lastname: Dadure
mesh_terms: D000577:Amides / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008442:Maxillary Nerve / Q000000981:diagnostic imaging*; D009266:Nalbuphine / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D056739:Pterygopalatine Fossa / Q000000981:diagnostic imaging; D011677:Punctures; D000077212:Ropivacaine; D014463:Ultrasonography
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D009266:Nalbuphine