Protocols in Cleft Lip and Palate Treatment: Systematic Review

Table 4

Conclusions of articles that addressed “postoperative pain relief”.

Postoperative pain relief*
Experimental group	Conclusion	Control	Explanation for the conclusion
Rectal Acetaminophen	>	Rectal placebo	In children who underwent palatoplasty, acetaminophen (40 mg/kg administered in the operating room at the end of surgery, and 30 mg/kg every 8 hours until 48 hours) was more effective in pain control than placebo [36].
Rectal Acetaminophen (40 mg/kg)	=	Rectal placebo	Acetaminophen and placebo were equivalents in regards to nauseas and vomits, the most frequent adverse effects [36]. Rectal acetaminophen (administered at anesthesia induction) did not result in analgesic plasma concentrations and it was not effective in pain control after palatoplasties [37].
Bilateral Palatal Block with Bupivacaine (0.5 mL of 0.25% solution at greater palatine, lesser palatine, and nasopalatine foramina)	=	Plain saline (0.5 mL at each point)	Bupivacaine and saline were effective in the palatal block and provided good parental satisfaction. Both provided better postoperative analgesia than the no block group [38].
Bilateral Infraorbital Nerve Block with Bupivacaine	>	Plain saline	In children who underwent cleft lip repair, the injection of 1.5 mL of 0.25% bupivacaine (extra-oral approach) [39] or 1–1.5 mL of 0.5% bupivacaine (intraoral approach) [40] in the area of; infraorbital foramen provided safe and prolonged postoperative pain relief (at least 8 hours [39]).

*All the alveoloplasties used iliac crest bone graft.