In search of the optimal pain management strategy for children undergoing cleft lip and palate repair: A systematic review and meta-analysis

Morzycki, Alexander; Nickel, Kevin; Newton, Dustin; Ng, Man Cho; Guilfoyle, Regan

doi:10.1016/j.bjps.2022.06.104

Cited by 8 publications

(8 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies investigating the topic of pain and analgesia were the most common (n=31; Supplemental Table 5, Supplemental Digital Content 5, http://links.lww.com/SCS/E642)12,13. Many of the included studies investigated the use of various analgesia techniques that aimed at reducing postoperative opioid consumption 2,14–29. Seven of the included studies investigated the effectiveness of bupivacaine for use in nerve block in cleft lip and/or palate repair 1,4,28,30–33.…”

Section: Resultsmentioning

confidence: 99%

“…Echaniz et al19 found that bilateral suprazygomatic maxillary nerve block in cleft lip and palate repair resulted in reduced nalbuphine ( P =0.02) and fentanyl ( P =0.07) consumption intraoperatively compared with bilateral infraorbital, greater and lesser palatine, and nasopalatine nerve blocks. In their meta-analysis, Morzycki et al21 found that palatine nerve block significantly lengthened the time to first postoperative analgesia in cleft palate repair but did not reduce overall opioid consumption. By comparison, in cleft lip repair bilateral infraorbital nerve blocks resulted in increased latency to first analgesia and decreased opioid consumption ( P <0.00001).…”

Section: Resultsmentioning

confidence: 99%

“…Many of the included studies investigated the use of various analgesia techniques that aimed at reducing postoperative opioid consumption. 2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Seven of the included studies investigated the effectiveness of bupivacaine for use in nerve block in cleft lip and/ or palate repair. 1,4,28,[30][31][32][33] All but 1 1 focused on infraorbital nerve block placement in cleft lip surgery patients.…”

Section: Pain and Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

Grue

McGuire

Hong

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Background: Cleft lip and/or palate repair techniques require continued reevaluation of best practice through high-quality evidence. The objective of this systematic review was to highlight the existing evidence for patient safety and quality improvement (QI) initiatives in cleft lip and palate surgery. Methods: A systematic review of published literature evaluating patient safety and QI in patients with cleft lip and/or palate was conducted from database inception to June 9, 2022, using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using Methodological Index for Non-Randomized Studies, Cochrane, or a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 instruments, according to study type. Results: Sixty-one studies met inclusion criteria, with most published between 2010 and 2020 (63.9%). Randomized controlled trials represented the most common study design (37.7%). Half of all included studies were related to the topic of pain and analgesia, with many supporting the use of infraorbital nerve block using 0.25% bupivacaine. The second most common intervention examined was use of perioperative antibiotics in reducing fistula and infection (11.5%). Other studies examined optimal age and closure material for cleft lip repair, early recovery after surgery protocols, interventions to reduce blood loss, and safety of outpatient surgery. Conclusions: Patient safety and QI studies in cleft surgery were of moderate quality overall and covered a wide range of interventions. To further enhance PS in cleft repair, more highquality research in the areas of perioperative pharmaceutical usage, appropriate wound closure materials, and optimal surgical timing are needed.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pain and Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

Grue

McGuire

Hong

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

show abstract

“…Our recommendation corresponds to the conclusions of a systematic review by Oberhofer and colleagues 21 who identify suprazygomatic maxillary nerve blocks as the preferred method for reducing pain in cleft palate surgery. In contrast, Morzycki et al 19 conclude that palatal nerve blocks demonstrate the greatest effectiveness in palatal repair, based on an their systematic review, but it included both randomized-and non-randomized controlled studies.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that additional confirmation was needed to reinforce the use of regional anesthesia techniques for cleft palate repair. 18 In their systematic review, which included 17 randomized and 10 nonrandomized controlled studies on cleft palate surgery, Morzycki Review and colleagues 19 found that palatine block provided the greatest latency to first analgesia compared with other block techniques and other analgesic interventions after cleft palate surgery. Pain scores were not assessed.…”

Section: Systematic Reviews Of Regional Anesthetic Techniquesmentioning

confidence: 99%

Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Suleiman,

Luedi,

Joshi

et al. 2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

Background/importanceCleft 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.ObjectivesThe 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 reviewMEDLINE, 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.FindingsOf 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.ConclusionThe present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients.PROSPERO registration numberCRD42022364788.

show abstract

Postoperative Pain Management in children: guidance from the Pain Committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative) Part II

Vittinghoff,

Lönnqvist,

Mossetti

et al. 2024

Anaesthesia Critical Care & Pain Medicine

View full text Add to dashboard Cite

In search of the optimal pain management strategy for children undergoing cleft lip and palate repair: A systematic review and meta-analysis

Cited by 8 publications

References 44 publications

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Postoperative Pain Management in children: guidance from the Pain Committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative) Part II

Contact Info

Product

Resources

About