Effect of Sphenopalatine Ganglion Block on Analgesic Requirements and Perioperative Outcomes in Children Undergoing Palatoplasty: A Randomized Controlled Trial

Abstract Background: Effective perioperative pain management is crucial in pediatric patients undergoing palatoplasty. This randomized controlled trial evaluated the effect of a preoperative bilateral sphenopalatine ganglion block (SPGB) using 0.5% bupivacaine on postoperative analgesic requirements and perioperative outcomes. Methods: Fifty children aged six months to three years undergoing palatoplasty were randomized into two groups: Group B (SPGB with 0.5% bupivacaine) and Group C (placebo with normal saline). The primary outcome was the need for rescue analgesia within the first hour post-extubation. Secondary outcomes included intraoperative anesthetic requirements (sevoflurane and fentanyl consumption), intraoperative hemodynamics, extubation time, postoperative pain (FLACC scale), and emergence delirium (PAED scale). Statistical analyses included independent t -tests, the chi-square tests, and repeated measures ANOVA. Results: The need for rescue analgesia within 1 hour was significantly lower in Group B (24%) compared with Group C (64%) ( P = 0.004). Group B also demonstrated reduced intraoperative sevoflurane (15.2 ± 2.6 mL vs. 23.5 ± 4.8 mL, P < 0 .001 ), lower fentanyl consumption (2.1 ± 0.4 µg/kg vs. 3.3 ± 0.5 µg/kg, P < 0 .001 ), and shorter extubation times (3.5 ± 0.6 min vs. 8.8 ± 1.4 min, P < 0.001). Postoperative pain and emergence delirium scores were also significantly lower in Group B. Conclusion: Preoperative bilateral SPGB with 0.5% bupivacaine significantly reduces postoperative analgesic needs and improves perioperative outcomes in children undergoing palatoplasty. SPGB is an effective adjunct for enhancing perioperative analgesia in pediatric surgical patients.