Background
Postoperative pain following pediatric cleft lip and palate repair provide unique
challenges. As no guidelines presently exist, we sought to identify the most effective
and safe perioperative pain management strategies for children undergoing primary
cleft lip and palate repair.
Methods
A systematic search of MEDLINE, Embase, Cochrane library, Scopus, and Web of Science
databases was conducted. A total of 230 unique titles were then assessed. Pooled analysis
of variables was conducted, and data pertaining to common approaches in decreasing
postoperative analgesia were compared.
Results
A total of 39 studies involving 583 and 1445 patients undergoing cleft lip and palate
repair, respectively, were included. In children undergoing cleft palate repair, palatine
block demonstrated the greatest latency to first analgesia (F(8,325) = 210, p<0.0001), but it was not associated with a decrease in total opioid consumption. In
cleft lip, bilateral infraorbital nerve blocks resulted in the greatest increase in
latency to first analgesia (215.76 min, 95% CI, 83.26 to 448.26, p<0.005) and demonstrated a mean decrease in morphine consumption of 0.2 mg/kg/d (95%
CI, -0.20 to -0.20, p<0.00001). No significant intervention-related complications were identified.
Conclusions
A variety of effective methods exist to decrease postoperative pain. In this review,
palatine nerve block demonstrates the greatest effectiveness in palate repair, while
bilateral infraorbital nerve block demonstrates an opioid-sparing effect and increased
the latency to first analgesia in cleft lip repair. All studied interventions demonstrated
safety in this pediatric cohort. The results of this review should be interpreted
in the context of certain limitations, including the number and nature of comparison
studies, and significant reporting heterogeneity.
Keywords
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 5,
2022
Received:
July 13,
2020
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
