背景:尽管上颌神经阻滞(MNB)在腭裂手术中提供了足够的疼痛缓解,它不是全球常规使用的,报道的技术是异构的。本研究旨在描述相关解剖结构,并根据现有文献和作者的专家意见提出MNB管理的首选技术。
方法:首先,一项调查已发送给阿姆斯特丹2023年国际腭裂硕士课程的432名注册人。第二,搜索了MEDLINE(PubMed接口)有关小儿患者上颌动脉(MA)解剖和MNB管理的相关文献。
结果:调查应答率为18%(n=78)。35名受访者(44.9%)在手术前使用MNB进行腭裂手术。最常见的报告是在切开前将针头重新定向到同侧连合的骨上入路,大多数情况下不使用超声波。包括10篇文章和20篇文章,分别,MA解剖学和MNB管理。47.5%至69.4%的MA在翼外肌浅表,32%至52.5%在内侧。最常描述的用于MNB管理的技术是骨上方法。针朝着对侧耳屏的前部重新定向似乎是最佳的。针头重新定向角度不必根据年龄进行调整,不同于针的深度。优选的麻醉剂是罗哌卡因或(左旋)布比卡因,以右美托咪定为佐剂。
结论:所描述的MNB技术在整个文献和调查受访者中具有异质性,未常规使用。需要进一步的研究,比较不同的技术的有效性和安全性。
BACKGROUND: Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors.
METHODS: First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients.
RESULTS: Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA\'s run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant.
CONCLUSIONS: Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.