Does sphenopalatine ganglion block improve pain control and intra-operative hemodynamics in children undergoing palatoplasty? A randomized control trial

Publication date: Available online 30 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anantanarayanan Parameswaran, Muruganand V. Ganeshmurthy, Yashoda Ashok, Manikandhan Ramanathan, Anthony F. Markus, Hermann F. Sailer
BackgroundChildren undergoing cleft palate repair suffer pain, dysphagia and wound irritation in the immediate post-operative phase which may compromise surgical outcome. This trial evaluates the efficacy of spheno-palatine ganglion block (SPGB) in optimizing intra-operative hemodynamics and post-operative analgesia in children undergoing primary palatoplastyMaterials and MethodsThe study was designed as a prospective, double blinded, randomized control trial comparing the use of SPGB with general anesthesia (GA) versus a control group of GA only. Routine pre-operative documentation included type of cleft, patient's weight, hemoglobin(Hb%), packed cell volume(PCV), blood pressure(BP) and echo-cardiogram. Intra-operative monitoring included heart rate, blood pressure and surgical field assessment. Post-operatively, the pain score, pain free duration and need for rescue analgesics were recorded. Post-surgical change in Hb% and PCV values were assessed. Data analysis of collected variables was done using SPSS Version 16 (IBM Corp, Chicago, USA). Quantitative data was assessed for normality using Shapiro Wilk's test and analysed using the Imdependent sample t test, and Fisher Exact test was used for comparison of the binary variable (Gender). The outcome variables were compared between the study and control groups after adjusting for confounding variables. P value of <0.05 was considered statistically significant.Results100 Patients undergoing primary palatoplasty under GA were randomised into control group A (N=49) and study group B (SPGB)(N=51). Three patients were excluded from the Control group due to changes in intraoperative anesthetic protocol. The results demonstrated stastistically significant differences in the post-surgical pain free duration (19.46 Vs 87.59 mins) and mean blood loss (105.5 Vs 62 mL), in favour of the study group. Surgical field and post-op reduction of Hb% and PCV were also significantly favourable for the study group.ConclusionWe conclude that the SPGB is a potent pre-emptive technique offering excellent perioperative analgesia, hemodynamic stability and a clear surgical field.



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