Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.
Acute Pain
Pain Management
Pain, Postoperative
REGIONAL ANESTHESIA
analgesia
Journal
Regional anesthesia and pain medicine
ISSN: 1532-8651
Titre abrégé: Reg Anesth Pain Med
Pays: England
ID NLM: 9804508
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
received:
27
09
2023
accepted:
27
11
2023
medline:
21
12
2023
pubmed:
21
12
2023
entrez:
21
12
2023
Statut:
aheadofprint
Résumé
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. 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. 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. 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. The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients. CRD42022364788.
Sections du résumé
BACKGROUND/IMPORTANCE
BACKGROUND
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
OBJECTIVE
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
METHODS
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
RESULTS
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
CONCLUSIONS
The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients.
PROSPERO REGISTRATION NUMBER
UNASSIGNED
CRD42022364788.
Identifiants
pubmed: 38124208
pii: rapm-2023-105024
doi: 10.1136/rapm-2023-105024
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
M Van de Velde
(M)
E Albrecht
(E)
H Beloeil
(H)
M P Bonnet
(MP)
G Dewinter
(G)
S M Freys
(SM)
G Joshi
(G)
H Kehlet
(H)
P Lavand'homme
(P)
P Lirk
(P)
D N Lobo
(DN)
E M Pogatzki-Zahn
(EM)
J Raeder
(J)
N Rawal
(N)
A R Sauter
(AR)
T Volk
(T)
C L Wu
(CL)
Informations de copyright
© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: GJ has received honoraria for consultation from Merck.