Ultrasound-guided suprazygomatic maxillary nerve blocks for pediatric cleft palate repair: a retrospective analysis

Background Effective opioid-sparing analgesia is essential in pediatric cleft palate repair, as infants and young children are vulnerable to opioid-related adverse effects. Ultrasound-guided suprazygomatic maxillary nerve (SZMN) blocks have emerged as a promising regional anesthesia technique, but evidence supporting their effectiveness remains limited. Methods We conducted a retrospective observational cohort study of pediatric patients younger than 18 years who underwent cleft palate repair at a single tertiary academic medical center between January 2020 and February 2023. The primary outcome was total perioperative opioid consumption, measured as morphine milligram equivalents per kilogram (MME/kg). Secondary outcomes included intraoperative and postoperative opioid use, time to first successful feeding, and length of hospital stay. Multivariable linear regression was used to adjust for potential confounders, including cleft type and perioperative factors. Results Seventy-four patients met inclusion criteria, of whom 28 received an ultrasound-guided SZMN block. Patients who did not receive an SZMN block consumed significantly more opioids (57% higher; 95% confidence interval [CI], 11.7–121.5; P = 0.012). After adjustment for cleft type and perioperative variables, absence of an SZMN block remained independently associated with higher opioid consumption (48.9% increase; 95% CI, 4.41–112.4; P = 0.031). Intraoperative opioid use was also significantly lower in the SZMN block group. No differences were observed in postoperative opioid use, time to first feeding, or hospital length of stay. Conclusions Ultrasound-guided SZMN blocks were associated with significantly reduced perioperative opioid consumption in pediatric cleft palate repair without prolonging recovery. Prospective studies are warranted to confirm these findings.