PURPOSE: Postoperative pain management in children undergoing cleft lip surgery has been traditionally achieved with narcotic medications. Regional anesthesia of the maxillary division of the trigeminal nerve has been extensively described in the dental literature for soft tissue and bone-related procedures. We employ a regional maxillary nerve block for patients undergoing cleft lip repair for regional anesthesia and to minimize postoperative narcotic use. The effects of a regional block on the pain cascade and neurotransmitters such as substance P are reviewed.

METHOD: The technique of maxillary nerve blockade is described in detail. A retrospective review of a single surgeon’s experience with performing cleft lip repairs with preoperative maxillary block. Peri- and postoperative narcotic use is examined. An extensive review of the literature is performed in regards to the maxillary block, the effects of substance P on pain sensation, and the methods of perioperative and postoperative pain control in cleft lip surgery.

RESULTS: When compared to operations performed without regional maxillary block, those performed with the block lead to less use of perioperative and postoperative narcotics for pain control. An algorithm of pre- and postoperative pain control regimen is proposed.

CONCLUSION: Preoperative maxillary block reduces the utilization of peri- and postoperative narcotics for pain management. The block is easy to perform with the described technique, has limited risk for complications, and is our preferred method of adjunctive anesthesia. Using the block with minimal narcotic medications postoperatively will minimize potential side effects while providing effective pain relief. The use of the maxillary block for postoperative pain control may be extended to any procedure that occurs within the maxillary nerve distribution, reconstructive or aesthetic.