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Application for ESRA Abstract Prizes:Background and Aims Cleft palate repair is one of the most common surgery performed in pediatric age group. Globally, the prevalence of cleft lip and/or cleft palate is 1 in 700 live births. Prevalence of isolated cleft palate is around 1 in 2000 live births. Asian population has higher incidence. There are major airway challenges in cleft palate and use of opioids for pain relief may exaggerate such problems in post operative period. Regional blocks like suprazygomatic maxillary nerve improve analgesia and also decrease opioid consumption.Methods A case series of 09 Pediatric patients ageing from 9 months to 18 months of age was done with ultrasound guided suprazygomatic maxillary nerve block (SZMN) analgesia using 0.25% 4 ml of Bupivacaine with 4 mg of dexamethasone given bilaterally. General Anesthesia was given with SZMN analgesia for cleft palate repair in a tertiary care hospital in Faridabad, Haryana over a period of 1 month. Neonatal Infant Pain Scale (NIPS) was used to assess post operative pain at 6, 12 and 24 hrs. Secondarily, the need and frequency for IV analgesia (paracetamol (PCM) or opioids) post operatively was also assessed.Results There was pain relief in 8 patients with NIPS score ranging between 1–3. However, one child was agitated and had NIPS score of 5. There was reduction in the need for IV PCM or opioid analgesia till 24 hrs.Conclusions SZMN block provides effective pain relief for pediatric patients in cleft palate repair. The analgesic technique should be standardized for all such surgeries.