Comparison of bupivacaine alone and in combination with fentanyl or pethidine for bilateral infraorbital nerve block for postoperative analgesia in paediatric patients for cleft lip repair: A prospective randomized double blind study

Mane, RajeshS; Sanikop, CS; Dhulkhed, VithalK; Gupta, Tuhina

doi:10.4103/0970-9185.76611

Cited by 14 publications

(16 citation statements)

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“…Flowchart demonstrating the selection and eligibility, screening, and final inclusion processes for cleft lip and cleft palate studies. Eleven 9–19 and six 12–17 studies were selected for qualitative and quantitative review, respectively, in the cleft lip category. Twelve studies 20–31 and two studies 11,20 were selected for qualitative and quantitative review, respectively, in the cleft palate category.…”

Section: Resultsmentioning

confidence: 99%

“…40 With regard to lip and palate repair, the use of such adjuvants was found to improve duration of analgesia postoperatively in several of the included studies. Specifically, the addition of fentanyl, 9 meperidine, 9,23,24 clonidine, 10 and dexmedetomidine 29 to bupivacaine were all individually found to improve postoperative pain over bupivacaine injection alone. In addition, liposomal bupivacaine, a long-acting local anesthetic, has gained popularity in recent years as an anesthetic that can provide prolonged analgesia in a multitude of procedures.…”

Section: Discussionmentioning

confidence: 99%

“…2). Qualitative analysis demonstrated that intraoperative regional nerve blocks are associated with decreased total postoperative opioid requirements, 9,12,13,15,16,22,24,26 lower incidence of postoperative nausea/vomiting, 13,18 and improved behavioral scores. 18 These results provide a high level of evidence for the routine incorporation of regional nerve blocks into cleft care perioperative pain management protocols.…”

Section: Discussionmentioning

confidence: 99%

“…9,12,13,15,16 Use of adjuvants in anesthetics for nerve blocks resulted in prolonged effective analgesia compared to controls. [9][10][11] Peri-incisional infiltration of bupivacaine was inferior to infraorbital nerve block for pain management, 19 as was intravenous opioid use. 18 Of the included studies, six randomized controlled trials provided sufficient data for metaanalysis, all of which evaluated the efficacy of intraoperative infraorbital nerve blocks in cleft lip repair.…”

Section: Cleft Lipmentioning

confidence: 99%

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Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Pfaff

Nolan

Musavi

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Developing effective strategies to manage perioperative pain remains a focus of cleft care. The present study’s purpose was to systematically review perioperative pain control strategies for cleft lip and palate repair. Methods: A systematic review and meta-analysis of randomized controlled trials was performed. Primary outcomes included pain scale scores and time to analgesia failure. Cohen d normalized effect size permitted comparison between studies, and a fixed-effects model was used for analysis. I2 and Q-statistic p values were calculated. Results: Twenty-three studies were included: eight of 23 studies provided data for meta-analytic comparison. Meta-analyses evaluated the efficacy of intraoperative nerve blocks on postoperative pain management. Meta-analysis included a total of 475 treatment and control patients. Cleft lip studies demonstrated significantly improved pain control with a nerve block versus placebo by means of pain scale scores (p < 0.001) and time to analgesia failure (p < 0.001). Measurement of effect size over time demonstrated statistically significant pain relief with local anesthetic. Palatoplasty studies showed significantly improved time to analgesia failure (p < 0.005) with maxillary and palatal nerve blocks. Multiple studies demonstrated an opioid-sparing effect with the use of local anesthetics and other nonopioid medications. Techniques for nerve blocks in cleft lip and palate surgery are reviewed. Conclusions: The present systematic review and meta-analysis of randomized controlled studies demonstrates that intraoperative nerve blocks for cleft lip and palate surgery provide effective pain control. Opioid-sparing effects were appreciated in multiple studies. Intraoperative nerve blocks should be considered in all cases of cleft lip and palate repair to improve postoperative pain management. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Cleft Lipmentioning

confidence: 99%

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Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Pfaff

Nolan

Musavi

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Furthermore, in a study conducted upon patients who underwent elective lower abdominal surgeries, Metwally and colleagues [21] found that the addition of fentanyl to local anaesthesia in ultrasound-guided TAP block, prolonged the time for first rescue. Many studies such as Mane and colleagues [29], Chavan and colleagues [30], and Sert and colleagues [31] have inferred that the addition of fentanyl to local anaesthetics improved the quality and duration of peripheral nerve blocks. However, some other studies such as Kalso et al [32] and Magistris et al [33] demonstrated that the addition of fentanyl or other opioids to local anaesthetics brought no significant and clinically relevant advantage for peripheral nerve blocks.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study

et al. 2022

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Background Transversus abdominis plane (TAP) block is beneficial for pain management after conducting abdominal surgery. Objective To compare the outcomes of dexmedetomidine and fentanyl, as adjuvants to bupivacaine, for ultrasound-guided TAP block analgesia among patients undergoing radical cystectomy for postoperative pain management. Methods This prospective, randomised, comparative study included a total of 60 patients, who underwent radical cystectomy. Participants were randomly divided into three categories with 20 subjects each; group B had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 2 ml normal saline; group BF had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg fentanyl dissolved in 2 ml normal saline and group BD had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg dexmedetomidine dissolved in 2 ml normal saline.The researchers recorded the time taken for first rescue analgesia, total analgesic dose in the first 24 h after surgery, patient satisfaction, sedation score, and postoperative complications. Results The time taken for first rescue analgesia was significantly lengthier in group (BD) (8.90 ± 2.47) than (BF) (6.50 ± 1.43) and (B) (4.40 ± 1.05) groups. The total nalbuphine consumption, during the first 24 h, was significantly lower in (BD) (0.15 ± 0.00) group compared to (BF) (0.20 ± 0.07) and (B) (0.24 ± 0.08) groups. Conclusion In comparison with fentanyl, as an adjuvant to bupivacaine, dexmedetomidine was found to be associated with prolonged postoperative analgesia, less postoperative pain scores and low opioid consumption. Trial registration This study was registered at Clinical Trials.gov on 23 March 2020 (registration number: NCT04318158).

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Infraorbital nerve block for postoperative pain following cleft lip repair in children

Feriani

Hatanaka

Torloni

et al. 2016

Cochrane Database of Systematic Reviews

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There is low- to very low-quality evidence that infraorbital nerve block with lignocaine or bupivacaine may reduce postoperative pain more than placebo and intravenous analgesia in children undergoing cleft lip repair. Further studies with larger samples are needed. Future studies should standardise the observation time and the instruments used to measure outcomes, and stratify children by age group.

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Comparison of bupivacaine alone and in combination with fentanyl or pethidine for bilateral infraorbital nerve block for postoperative analgesia in paediatric patients for cleft lip repair: A prospective randomized double blind study

Cited by 14 publications

References 0 publications

Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study

Infraorbital nerve block for postoperative pain following cleft lip repair in children

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