Long Acting Local Anaesthetic Agents as Alternative or Adjuvants to Systemic Analgesics in Management of Immediate Postoperative Pain Following Cleft Palate Surgeries-A Systematic Review
To systematically identify, evaluate and assess the efficacy of systemic analgesics with that of long acting local anaesthetic agents in management of post-operative pain in patients undergoing palatoplasty. Objective: To identify, appraise and assess the available evidence in literature on the use of long acting amide local anaesthetic agent as an alternative and/or adjuvant to systemic analgesics in management of post-operative pain in paediatric patients undergoing palatoplasty which in turn may lead to reduction in complications associated with opioid/NSAIDs consumption. Methods: A comprehensive search was done using electronic databases of PubMed, Google Scholar and Cochrane central register of controlled trials were searched for related studies along with a complementary manual search of relevant journals using PICO terms. The title scan was done to identify relevant articles, which were further evaluated for inclusion by reading the abstract. Bibliography of all the identified studies was scanned to include studies published outside the electronic database. Results: Electronic database search identified 29 articles. Out of which, 19 were excluded after removing duplication and 15 were excluded after reading titles. 4 studies were evaluated in detail after reading the abstract and full text. A final of 2 studies were included based on the inclusion criteria to meet the research question. The studies analysed quantity and need for post-operative rescue analgesia in patients undergoing palatoplasty. Conclusion: Cleft palate repair is a painful procedure which needs a standardised approach to address post-operative pain in children. The available evidence based on the included studies show those loco-regional nerve blocks with long acting amide local anaesthetic agents are a safe, effective and simple measure for management of postoperative pain in a predictable manner after palatoplasty. Regional anaesthesia also reduces the total consumption of systemic analgesics in the first 48 hours post operatively. However, limited number of studies is available, hence we can only draw a guarded conclusion that postoperative complications associated with systemic analgesics can also be reduced in children.