Rossell-Perry Percy, Romero-Narvaez Carolina, Rojas-Sandoval Ruth, Gomez-Henao Paula, Delgado-Jimenez Maria Pia, Marca-Ticona Renato
Edgardo Rebagliatti Hospital, Lima, Peru.
South American Medical Advisory Council, Smile Train Foundation, New York, N.Y.
Plast Reconstr Surg Glob Open. 2021 Jan 22;9(1):e3355. doi: 10.1097/GOX.0000000000003355. eCollection 2021 Jan.
Pharmacologic treatment of postoperative pain after cleft palate repair includes opioids and nonopioid analgesics, nerve blocks, and local anesthetic infiltration. Use of opioids in infants has concerns regarding sedation, risk of aspiration, respiratory depression, and respiratory distress. The main objective of this review was to analyze information available on the safety of the use of opioids during perioperative management of pain related to primary cleft palate repair in published studies.
A systematic review of the literature for studies published until March 2020 was performed to evaluate the safety of opioid drugs during primary cleft palate repair pain management. The authors chose the following MesH terms for this systematic review: cleft lip and palate AND opioids AND pain management. The investigators performed a systematic literature search using the Pubmed/MEDLINE, Embase, Web of Science, and Cochrane Library databases.
After a literature search resulting in 70 identified studies, 9 were qualified for the final analysis, which included 772 patients. There was a high level of evidence in the selected studies according to the Oxford CEBM Level of Evidence classification and GRADE scale. The most common adverse event reported was postoperative nausea and vomiting (from 5% to 25%). Episodes of oxygen desaturation have been reported from 2.5% to 7.4% of the studied patients.
s: Definitive conclusions about the safety of opioid drugs during primary cleft palate repair pain management cannot be drawn. Vomiting and oxygen desaturation have been associated with the use of opioids in the studied population.
腭裂修复术后疼痛的药物治疗包括使用阿片类药物和非阿片类镇痛药、神经阻滞以及局部麻醉药浸润。在婴儿中使用阿片类药物存在镇静、误吸风险、呼吸抑制和呼吸窘迫等问题。本综述的主要目的是分析已发表研究中关于在原发性腭裂修复相关疼痛的围手术期管理中使用阿片类药物安全性的现有信息。
对截至2020年3月发表的研究进行文献系统综述，以评估阿片类药物在原发性腭裂修复疼痛管理中的安全性。作者为该系统综述选择了以下医学主题词：唇腭裂、阿片类药物和疼痛管理。研究人员使用PubMed/MEDLINE、Embase、科学网和考克兰图书馆数据库进行了系统的文献检索。
在文献检索得到70项已识别研究后，9项符合最终分析要求，其中包括772例患者。根据牛津循证医学中心证据水平分类和GRADE量表，所选研究中有高水平证据。报告的最常见不良事件是术后恶心和呕吐（5%至25%）。在所研究患者中，氧饱和度下降事件的报告发生率为2.5%至7.4%。
关于阿片类药物在原发性腭裂修复疼痛管理中的安全性无法得出明确结论。在所研究人群中，呕吐和氧饱和度下降与阿片类药物的使用有关。
