A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost

Vu, Giap H.; Humphries, Laura S.; Zimmerman, Carrie E.; Kalmar, Christopher L.; Bartlett, Scott P.; Swanson, Jordan W.; Taylor, Jesse A.

doi:10.1097/prs.0000000000007987

Cited by 2 publications

(2 citation statements)

References 39 publications

(62 reference statements)

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“…For palatoplasty, certain combinations of local anesthetics have been demonstrated to decrease hospital length of stay and hospital cost. 39 To our knowledge, this is the first study to compare the effectiveness of lidocaine and bupivacaine for cleft lip repair. After adjusting for several confounders, including unilateral versus bilateral repair, utilization of both lidocaine and bupivacaine concurrently was independently associated with decreased postoperative narcotic utilization ( P < .001) (Figure 4).…”

Section: Discussionmentioning

confidence: 96%

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

Kalmar

Zapatero

Kosyk

et al. 2022

The Cleft Palate Craniofacial Journal

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To analyze whether the choice of intraoperative local anesthetic for cleft lip repair is associated with the amount of perioperative narcotic utilization. Retrospective cohort study. Hospitals participating in the Pediatric Health Information System. Primary cleft lip repairs performed in the United States from 2010 to 2020. Local anesthesia injected—treatment with lidocaine alone, bupivacaine alone, or treatment with both agents. Perioperative narcotic administration. During the study interval, 8954 patients underwent primary cleft lip repair. Narcotic utilization for unilateral ( P < .001) and bilateral ( P = .004) cleft lip repair has decreased over the last 5 years. Overall, 21.8% (n = 1950) of infants were administered perioperative narcotics for cleft lip repair, such that 14.3% (n = 1282) required narcotics on POD 0, and 7.2% (n = 647) required narcotics on POD 1. In this study, 36.5% (n = 3269) patients received lidocaine, 22.0% (n = 1966) patients received bupivacaine, and 19.7% (n = 1762) patients received both local anesthetics. Administration of any perioperative narcotic was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine ( P = .001, 17.5% vs 21.7%) or only bupivacaine ( P < .001, 17.5% vs 22.9%). Narcotic utilization on the day of surgery was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine ( P < .001, 11.5% vs 15.1%) or only bupivacaine ( P = .004, 11.5% vs 14.6%). Narcotic utilization on the first postoperative day was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only bupivacaine ( P = .009, 5.9% vs 8.1%). Conclusions In children undergoing cleft lip repair, local anesthetic combination of lidocaine and bupivacaine is associated with decreased perioperative narcotic use compared to lidocaine or bupivacaine alone.

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Section: Discussionmentioning

confidence: 96%

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

Kalmar

Zapatero

Kosyk

et al. 2022

The Cleft Palate Craniofacial Journal

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“…Methods to measure blood loss during palatoplasty are challenging but achieved by measuring blood soaked swabs and the volume of intraoperative suction amounts. 1 Methods to decrease the intraoperative blood loss include the use of adrenaline in the local anesthetic mix placed into the palate during surgery 21 and the use of intravenous tranexamic acid. 22,23 Treatment for late bleeding postcleft palate repair involves supportive cares with fluids, blood transfusion as required, intravenous tranexamic acid, and a return to theatre as required.…”

Section: Discussionmentioning

confidence: 99%

Late Bleeding Following Cleft Palate Repair: An Under-Reported Finding?

Wheeler

Sanders

2021

Journal of Craniofacial Surgery

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The objective of this article is to assess the incidence of late bleeding following cleft palate repair (palatoplasty) in children. This is a retrospective review of a prospectively maintained database of patients treated for Cleft Lip and Palate in a tertiary academic pediatric hospital setting over 2 hospitals (Middlemore and Starship Hospitals) under the same multidisciplinary team of the Auckland Regional Cleft and Craniofacial Service, New Zealand. All patients with a diagnosis of Cleft Lip and/or Palate undergoing primary cleft palate repair over an 11 year period until March 2020 were included in the study. Our results found there were 482 patients with a new diagnosis of Cleft Lip and/or Palate from Jan 2009 through to March 2020. Three hundred sixty-six of those patients underwent primary palatoplasty at an average age of 10.5 months (range 8-18 months). The sub-types of cleft palate diagnoses were one-third Veau I, one-third Veau II, and the remaining one-third were Veau III, IV, and submucous cleft palate. One-third were syndromic. A total of 6 patients were re-admitted to hospital after discharge from their primary admission with bleeding from the cleft palate surgical site. Of the 6 patients re-admitted, 5 needed blood transfusions and 4 required an urgent return to the operating room. The authors found the rate of late bleeding following primary cleft palate repair in our unit is 1:61 operations or 1.6%. Late bleeding following cleft palate surgery is not well reported in the literature.

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A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost

Cited by 2 publications

References 39 publications

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

Late Bleeding Following Cleft Palate Repair: An Under-Reported Finding?

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