Cleft lip repair is a common operation in infants and requires that the child is
pain-free during the postoperative period so that handling does not affect the integrity of the delicate surgical site. This study was designed to compare the efficacy and duration of effect of 0.125%
bupivacaine given preoperatively as a bilateral infraorbital
nerve block with peri-incisional infiltration of the same local anaesthetic for postoperative
analgesia in
cleft lip repair. It was a randomised, double blind, prospective study in 30 children aged 4-20 months (ASA grade 1). After a standard induction, group A (n = 15) were given a bilateral infraorbital
nerve block with 0.125%
bupivacaine and group B (n = 15) had peri-incisional infiltration with the same
solution. No additional systemic
analgesics were given before or during the operation. Intraoperative monitoring comprised measurement of heart rate and blood pressure and post-operatively
pain relief was recorded using a behavioural
pain relief score. The heart rate, respiratory rate, and blood pressure were also monitored at 0, 1, 2, 4, 8, and 24 hours after tracheal extubation. The results showed that group A had significantly better
pain relief (higher scores) than group B for eight hours postoperatively (p < 0.05). The
analgesic requirement in group B became significant at two hours postoperatively, while group A had significant
analgesic requirements only after eight hours. The significant rise in heart rate and blood pressure that accompanied tracheal intubation in both groups suggested that while both methods of
analgesia may be adequate to prevent responses to skin incision, they do not substitute for adequate systemic
analgesia during the operation. We conclude that infraorbital
nerve block with 0.125%
bupivacaine provides better and more prolonged
analgesia than peri-incisional infiltration in
cleft lip repair.