The effect of infraorbital nerve block on emergence agitation in children undergoing cleft lip surgery under general anesthesia with sevoflurane.

BACKGROUND

Sevoflurane is widely used in pediatric anesthesia. However, a high incidence of emergence agitation (EA) after general anesthesia with sevoflurane has been reported and pain has been regarded as a significant contributing factor. The objective of this prospective randomized, placebo-controlled trial was to determine whether infraorbital nerve block reduces EA in children undergoing repair of cleft lip after sevoflurane.

METHODS

In this randomized, placebo-controlled trial, we enrolled 110 children (5 months to 6 years of age), who were scheduled for cleft lip surgery, and randomized them to the following two groups: Group S and Group B, where 1.5 ml saline (Group S) or 1.5 ml 0.25% bupivacaine (Group B) were administered in the infraorbital foramen. Emergence behavior was assessed in the postanesthesia care unit using the Pediatric Anesthesia Emergence Delirium (PAED) scale and a 5-point scale described by Cole. Pain was evaluated using the Children and Infants Postoperative Pain Scale (CHIPPS).

RESULTS

One-hundred children (n = 50 per group) completed the study. The endtidal concentration of sevoflurane in Group B was lower than that in Group S. The incidence of EA was 16% in Group B and 42% in Group S (P = 0.008). The PAED scale score in Group B (mean [95% CI] 9 [8-12]) was lower than that in Group S (11.5 [9.8-15]). The duration of EA in Group B was shorter than that in Group S. CHIPPS score in postanesthetic care unit were lower in Group B (mean [95% CI] 3 [2-3.3]) compared with that in Group S (5 [4-6]).

CONCLUSION

In children undergoing cleft lip repair surgery, infraorbital nerve block at the beginning of surgery significantly decreased the incidence of EA and the duration of EA, and provided satisfactory postoperative analgesia without delaying the time to extubation with sevoflurane anesthesia.