Comparative study of greater palatine nerve block and intravenous pethidine for postoperative analgesia in children undergoing palatoplasty.

Greater palatine nerve block anaesthetizes posterior portions of the hard palate and its overlying soft tissues. This study compared the efficacy, safety, and ease of the nerve block for cleft palate surgeries in children with i.v. pethidine for postoperative pain management. A prospective, double blind, randomized trial, enrolled 50 children aged below 10 years scheduled for palatoplasty and were alternatively allocated to two groups. Group A received intravenous pethidine 1mg.kg(-1), whereas Group B, bilateral greater palatine nerve block with bupivacaine 0.25%, 1ml on each side, before the surgical stimulation. Modified Aldrete Scoring System, Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Brussels Sedation Score were employed to assess recovery, quality of analgesia and sedation respectively, by the nursing staff. Whenever pain score was >8, 0.5mg.kg(-1) of pethidine was given intravenously for rescue analgesia in both groups. Recovery scores were better in Group B (p=0.007). In the immediate postoperative period, pain score was more in Group A (number of patients with pain score >8, 44% v/s 12%, p= .0117). Requirement for rescue analgesia was more in Group A (60 times v/s 7). The average sedation scores were similar. There was a higher incidence of agitation in Group A (66 vs. 30). The incidence of deep sedation was nearly half in Group B (34 Vs 63). Greater palatine nerve block was considered successful in 88% of cases. Greater palatine nerve block produces more effective, consistent and prolonged analgesia than pethidine.