A Systematic Review of Perioperative Nerve Blocks for Cleft Lip and Palate Surgeries

Abstract

Establishing a successful perioperative technique for better outcomes remains a priority in cleft surgery. In the present review, the safety and efficacy of nerve blocks for cleft lip and cleft palate are evaluated. A systematic review of randomized controlled trials (RCTs) involving the perioperative nerve block was conducted. PubMed, Google Scholar databases, and manual searching were performed to screen the eligible RCTs. Dosage and the route of administration of anesthetics were considered for all the studies. A total of nine RCTs with 568 children were included in our review. Six out of nine studies reported cleft lip surgery, only two reported cleft palate surgery, and one study reported both cleft lip and palate surgery. Lignocaine, ropivacaine, or bupivacaine was used as anesthetics. Adrenaline or epinephrine was used as adjuvants. Post-operative pain was lower in the perioperative nerve block group compared to the comparison group, resulting in fewer emergency analgesic prescriptions. Physiological factors like heart rate, blood pressure, and respiratory rate did not differ between groups. There were fewer adverse outcomes linked with perioperative nerve blocks. Perioperative nerve blocks can be a useful adjunct to general anesthesia in cleft lip and palate surgeries to provide additional pain relief and reduce opioid use, but they should be used judiciously and with consideration of potential risks and complications.

Keywords

• anesthetics
• infraorbital nerve
• opioids
• pediatric
• suprazygomatic maxillary nerve