Article Text
Abstract
Background/importance Cleft palate surgery is associated with significant postoperative pain. Effective pain control can decrease stress and agitation in children undergoing cleft palate surgery and improve surgical outcomes. However, limited evidence often results in inadequate pain control after cleft palate surgery.
Objectives The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after cleft palate surgery using procedure-specific postoperative pain management (PROSPECT) methodology.
Evidence review MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials and systematic reviews assessing pain in children undergoing cleft palate repair published in English language from July 2002, through August 2023.
Findings Of 1048 identified studies, 19 randomized controlled trials and 4 systematic reviews met the inclusion criteria. Interventions that improved postoperative pain, and are recommended, include suprazygomatic maxillary nerve block or palatal nerve block (if maxillary nerve block cannot be performed). Addition of dexmedetomidine to local anesthetic for suprazygomatic maxillary nerve block or, alternatively, as intravenous administration perioperatively is recommended. These interventions should be combined with a basic analgesic regimen including acetaminophen and nonsteroidal anti-inflammatory drugs. Of note, pre-incisional local anesthetic infiltration and dexamethasone were administered as a routine in several studies, however, because of limited procedure-specific evidence their contribution to pain relief after cleft palate surgery remains unknown.
Conclusion The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients.
PROSPERO registration number CRD42022364788.
- analgesia
- Pain, Postoperative
- Pain Management
- REGIONAL ANESTHESIA
- Acute Pain
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Footnotes
Collaborators PROSPECT Working Group: M Van de Velde, E Albrecht, H Beloeil, M P Bonnet, G Dewinter, S M Freys, G Joshi, H Kehlet, P Lavand’homme, D N Lobo, E M Pogatzki-Zahn, J Raeder, N Rawal, A R Sauter, T Volk, C L Wu.
Contributors NNS, MML, and ARS conducted the literature search. NNS, MML, GS, and ARS analyzed the retrieved data and wrote the manuscript. GD and CLW helped establish the guidelines based on the data presented by NNS, MML, and ARS and helped improve the manuscript. Final approval of completed article and guarantor: ARS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests GJ has received honoraria for consultation from Merck.
Provenance and peer review Not commissioned; externally peer reviewed.
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