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Regional Anesthesia for Cleft Lip Repair: A Preliminary Study

Objective To assess whether local anesthetic blockade of the infraorbital nerve may allow for cleft lip repair to be performed under regional anesthesia. Method Twenty patients above 12 years of age with cleft lip (7 females and 13 males) were enrolled. Careful preoperative counseling was given. Bilateral infraorbital block was performed (extraoral approach) with 10 mL of equal volumes of 2% lidocaine with 1:200,000 adrenaline and 0.5% bupivacaine. The point of entry was the intersection of a vertical line through the pupil of the eye (in the neutral position) and a horizontal line through the ala of the nose. The needle was directed medially and cephalad until the infraorbital foramina was reached and 2 mL was injected. Through the same point of entry, but directed medially (toward the ala), 1 mL was injected followed by a 2-mL injection caudally and medially (into the lip). Results The block was successful in all patients without complication. The surgery was uneventful, lasting between 45 and 60 minutes. The postoperative duration of analgesia was between 6 and 24 hours (mean 16.5 ± 5.10 SD). Conclusions The nerve supply of the cleft lip, our modification of the block, and possible problems with this technique are discussed. This study confirms the utility of this block for postoperative analgesia. Further studies are required to apply this innovative, safe, and economical modification of anesthesia for cleft lip surgery.