Continuous Bupivacaine Infusion Post-Iliac Crest Bone Graft Harvesting in Pediatric Cleft Surgery: Role and Comparison with Ketorolac

Hayes, Jason; Forrest, Christopher R.; Walsh, William R.; Petroz, Guy C.; Adeli, Khosrow; Bissonnette, Bruno

doi:10.1597/10-148

Cited by 8 publications

(2 citation statements)

References 23 publications

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“…However, the high resorption rate during the first year after grafting is the first limitation [ 33 ]. The second limitation is the complications related to harvesting: postoperative pain, difficulty in walking, nerve damage, hematomas, infections, and arterial wounds have been described [ 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Facial Cleftsmentioning

confidence: 99%

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery

et al. 2021

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Cleft lip and palate is the fourth most common congenital malformation. Its prevalence is about 1 in 750 to 1 in 2000 live births. The consequences of this malformation are major: maxillary growth deficit, unaesthetic appearance, phonation disorders, difficulty in eating, and psycho-social disorders. Cleft palate repair establishes the division between the oral and nasal cavities. The alveolar bone graft is a key step. Different sites of autogenous bone harvesting are used, the most common being the iliac crest. Nevertheless, the large number of complications associated with harvesting has led to the use of substitute biomaterials. Bioactive glasses, discovered in 1969, are a group of synthetic silica-based materials with bone-bonding properties. Although 45S5 granular composition is commonly used in bone surgery to repair critical defects, it is only rarely used in the repair of cleft palates because this galenic form is only moderately adapted. However, advances in bone tissue engineering allow the shaping of three-dimensional scaffolds, which support colonization by host cells. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) have even led to the 3D printing of scaffolds combining 45S5 bioglass with a natural and biocompatible poly-lactic acid matrix. The shape of the parts is customized and adapted to the particular shape of the critical bone defects. The objective of this literature review is to highlight the particularities of alveolar defects subsequent to facial clefts, then to detail the characteristics of the materials and technologies used to elaborate 3D matrices by bioprinting. Finally, we will explore research directions regarding their use in reconstructive surgery of cleft palates.

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Section: Facial Cleftsmentioning

confidence: 99%

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery

et al. 2021

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“…Other studies have examined the effect of intraoperative anesthetics, demonstrating the intraoperative use of dexmedetomidine and ketamine reduced the need for postoperative opioids [7]. Finally, when performing alveolar bone grafting, managing donor site pain has been explored in a variety of ways [8–11]. There has been recent research into expanding the use of, and the indications for, peripheral nerve blockade in oral and head and neck procedures including palatoplasty in the aftermath of the opioid epidemic in North America and elsewhere [12,13,14 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative pain management in pediatric cleft lip and palate repair

Flowers

Winters

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review 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 findings 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. Summary 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.

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Ketorolac for postoperative pain in children

McNicol

Rowe

Cooper

2018

Cochrane Database of Systematic Reviews

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Continuous Bupivacaine Infusion Post-Iliac Crest Bone Graft Harvesting in Pediatric Cleft Surgery: Role and Comparison with Ketorolac

Abstract: Iliac crest donor-site pain is well managed in this patient population. Intravenous ketorolac and iliac crest bupivacaine infusion provide comparable analgesia for iliac crest bone graft donor-site pain in children and adolescents.

Cited by 8 publications

References 23 publications

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery

Postoperative pain management in pediatric cleft lip and palate repair

Ketorolac for postoperative pain in children

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