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Background and Aims Cleft palate surgery in low-resource countries presents significant anesthetic challenges, particularly in achieving effective perioperative analgesia with limited access to opioids and advanced monitoring. Here, we share our experience with the suprazygomatic maxillary nerve block (SMB) as part of a multimodal analgesic strategy during cleft palate repair in such low resource settings. SMB provides reliable sensory blockade of the hard and soft palate. In our outreach mission to Laos, we implemented this technique in paediatric patients undergoing cleft surgery to reduce intraoperative opioid use and improve recovery profiles.Methods On this mission, the children undergoing cleft surgery received a local anaesthetic infiltration to the surgical site at the start of surgery, and fentanyl 0.5–1 mcg/kg at induction. At the end of the surgery, the suprazygomatic nerve block was performed under ultrasound guidance, with 0.1–0.15 ml/kg/side of 0.2% bupivacaine. In the recovery area, none of the children had pain requiring rescue opioids. As part of the protocol, all children received paracetamol 15 mg/kg and ibuprofen 10 mg/kg. There were no noted complications from the block administration, and patients also did not have any nausea or vomiting.Results Our experience demonstrated a reduction in opioid requirements and lower rates of emergence agitation. Patients receiving the block experienced smoother recoveries, with many achieving early discharge, a critical advantage in such low-resource surgical environments where postoperative monitoring and support were limited. Training local anesthesia providers in SMB was feasible and well-received, highlighting its potential for sustainable implementation. With basic ultrasound equipment and focused hands-on teaching, local teams were able to adopt the technique confidently.Conclusions In conclusion, our experience supports the use of the suprazygomatic maxillary nerve block as a safe, effective, and resource-efficient adjunct in cleft palate surgery. Its integration into global surgery initiatives can improve perioperative care and promote safer anesthesia practices in underserved regions.