Suprazygomatic maxillary blocks fed children better than palatine blocks after cleft palate repair

Design

Prospective randomised clinical trial

Population

60 children aged 1 to 10 years having palate surgery (30 per group)

Primary outcome

Oral feeding in the first 24 hours as a percentage of normal

Effect

Median 80% vs 60% for suprazygomatic vs palatine block (p<0.00001)

A randomised trial allocated 60 children aged 1 to 10 years having palate surgery to bilateral suprazygomatic maxillary nerve blocks or greater palatine nerve blocks, 30 per group, with no missing data. The primary outcome was oral feeding in the first 24 hours as a percentage of full normal feeding.

Median feeding was 80% (range 70 to 90) with the suprazygomatic block against 60% (range 40 to 70) with the palatine block (p<0.00001). Pain scores in the first 12 hours were lower and fewer children needed rescue paracetamol with the suprazygomatic approach.

The trial is small and single-centre in design as far as the abstract shows, and comparison was between two blocks, so it cannot show the size of benefit over no block. It supports choosing the technique that also protects feeding, which matters in small children whose recovery depends on eating.

• Consider the suprazygomatic maxillary block where feeding recovery is a priority after palate surgery.
• Feeding at 24 hours was higher: median 80% against 60% of normal intake.
• Early pain scores and rescue paracetamol use were lower with this block.
• Sixty children is small; teams new to the block should build experience under supervision.

Why it matters

It adds feeding, a practical recovery measure, to the criteria for choosing a block in cleft surgery.

Don't overread it

Sixty children compared two blocks only; the pain and rescue results were secondary.

The statistics, in plain English

A p-value below 0.00001 in 60 children means the difference in feeding was large relative to the spread. It does not tell you whether the same gap would appear in a different team's hands or in younger infants.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.