الفهرس 
ACKNOWLEDGMENT
BLOOD SUPPLY OF THE PALATEOnly 14 pages are availabe for public view
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Abstract
The current study was done at Assuit University Hospitals between November 2016 and September 2018 and included 80 pediatric patients (1- 5 years, ASA I-II). Patients were randomly allocated into 2 groups; each one included 40 patients who underwent primary cleft palate repair under GA and bilateral SMB using either dexmedetomidine and bupivacaine or bupivacaine alone for postoperative analgesia. Written consent, coagulation profile, IV line, emergency resuscitation equipments including airway devices, advanced cardiac life support drugs for LA toxicity were prepared. Patients were monitored using standard monitoring (ECG, non- invasive blood pressure, pulseoximetry and capnography). Blood pressure readings, capnography, sedation scores, postoperative pain scores and need for analgesia were obtained. Results showed:- Regarding HR and MAP, it was noticed that both had no statistically significant differences between both groups immediately after the block but their readings were significantly lower in children received bupivacaine with dexmedetomidine at time of skin incision, 30 min, 60 min later, at end of surgery and postoperatively till 24 h in comparison to those received bupivacaine alone (P< 0.001). Regarding SpO2 and ETCO2, it was noticed that they had no statistically significant differences at induction time, immediately after the block, at time of skin incision, 30, 40, 50, 60 min later and at end of surgery in comparison to the baseline data in both groups (P> 0.05). Regarding postoperative pain scores , modified CHEOPS was significantly lower in children received bupivacaine with dexmedetomidine in comparison to those children received bupivacaine alone at different times of follow up postoperatively (1, 4, 8, 12, 18 and 24 h postoperatively). Regarding frequency of postoperative analgesic request, no child from those received bupivacaine with dexmedetomidine required analgesia while all children received bupivacaine alone required analgesia at different times. Median time to 1st analgesic requirement was 10 h with range between 8 and 12 h while median frequency of analgesic requirement was 2 times with range between 2 and 3 times. Regarding sedation, it was noticed that sedation score was significantly higher in those children received bupivacaine with dexmedetomidine in comparison to those children received bupivacaine alone during the first postoperative hour (P= 0.03). According to our results, we can conclude that the addition ofug/kg dexmedetomidine to bupivacaine in bilateral SMB in children undergoing primary cleft palate repair achieves better pain control postoperatively as compared to using bupivacaine alone in the same population, as evidenced by significantly less need for postoperative rescue analgesia specially opioids as well as lower pain scores up to 24 h postoperatively without any major side effects. RECOMMENDATIONS: The SMN block was done by a blind technique according to landmarks. Safety and feasibility of the block can be increased by stimulating the temporal muscle using the nerve stimulator. The pterygopalatine fossa position is just behind the muscle; disappearance of the muscular response to direct stimulation with the block needle indicates its tip is in the infratemporal fossa. The pterygopalatine fossa could also be localized with ultrasound guidance. Moreover, the use of ultrasound imaging may be useful if the distance between skin and pterygomaxillary fossa were slightly modified by the presence of the cleft palate.