Department of Otolaryngology, Tulane University.
Department of Otolaryngology, Ochsner Clinic Foundation, New Orleans, LA, USA.
Curr Opin Otolaryngol Head Neck Surg. 2021 Aug 1;29(4):294-298. doi: 10.1097/MOO.0000000000000719.
There has been an increased interest in the literature on methods to improve perioperative outcomes in surgical patients while minimizing opioid use. Pediatric cleft palate repair can be a painful procedure, and this postoperative pain can lead to longer hospital stays and worse surgical outcomes.
Recent literature has explored four key areas surrounding analgesia after cleft lip and palate repair. These areas are management of postoperative pain with nonopioid oral analgesics, peripheral nerve blockade, liposomal bupivacaine for donor-site analgesia in bone grafting, and enhanced recovery after surgery (ERAS) protocols.
The included studies indicate that patients undergoing palatoplasty may have a decreased opioid requirement if nonopioid analgesics such as acetaminophen and ibuprofen are started early in the postoperative setting. Peripheral nerve blockade is an important adjunct to analgesia in these patients. Suprazygomatic maxillary nerve blockade may improve pain management over traditional infraorbital nerve blockade. In patients undergoing alveolar bone grafting, injection of liposomal bupivacaine into the donor site can significantly decrease oral opioid requirements. Finally, ERAS protocols are emerging ways to decrease postoperative pain in cleft palate patients.
人们对减少围手术期阿片类药物使用量、改善手术患者预后的方法越来越感兴趣。小儿腭裂修复是一个痛苦的过程，术后疼痛可导致住院时间延长和手术预后不良。
最近的文献探讨了腭裂修复术后镇痛的四个关键领域。这些领域包括：非阿片类口服镇痛药治疗术后疼痛、周围神经阻滞、脂质体布比卡因用于骨移植供区镇痛、术后加速康复（ERAS）方案。
纳入的研究表明，如果在术后早期使用非甾体类镇痛药（如对乙酰氨基酚和布洛芬），接受腭裂修复术的患者可能需要较少的阿片类药物。周围神经阻滞是这些患者镇痛的重要辅助手段。相较于传统眶下神经阻滞，上颌神经颧支阻滞可更好地管理疼痛。在接受牙槽骨植骨术的患者中，将脂质体布比卡因注射到供区可显著减少口服阿片类药物的需求。最后，ERAS 方案是减少腭裂患者术后疼痛的新兴方法。
