Nerve block for pain management in pediatric patients undergoing cleft lip and palate repair: A systematic review and network meta-analysis

IF 2 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2025-03-18 DOI:10.1016/j.bjps.2025.03.036

Nawaf Alhindi , Houriah Nukaly , Lina Abdulrahman , Sarah Alzolaibani , Mousa Akkour , Abdulaziz Abumelha , Deemah Alhuraish , Razan Albrahim , Reemah AlQahtani , Sami I. Alissa

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引用次数: 0

Abstract

Background

Cleft lip and palate, a common congenital anomaly, occurs in approximately 1 in every 1000–1500 births. Effective postoperative pain management in pediatric patients undergoing repair for cleft lip and palate remains a challenge. Therefore, this systematic review and network meta-analysis aimed to assess the effectiveness of nerve block in controlling postoperative pain compared to other methods in pediatric patients who underwent cleft lip and palate repair.

Methods

This review adhered to the preferred reporting items for systematic reviews and meta-analysis guidelines. A comprehensive search was conducted across multiple databases, including Embase, MEDLINE, Cochrane, and SCOPUS, without time frame limitation.

Results

A total of 8 randomized controlled trials comprising 550 patients were included. The findings of the study indicate that dexmedetomidine provided longer duration of nerve block (incremental value = 6.33, CI 95%, 1.49: 11.16) compared to the control. Thus, the probability of dexmedetomidine achieving longer nerve block is 89.98%. This was followed by fentanyl and pethidine.

Conclusion

This study supports the efficacy and safety of nerve blocks, particularly with dexmedetomidine, for postoperative pain management in pediatric cleft lip and palate repair. Adjuvant-enhanced nerve blocks offer extended pain relief and reduce the reliance on opioids.

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神经阻滞治疗小儿唇腭裂修复患者疼痛：系统回顾和网络荟萃分析

唇腭裂是一种常见的先天性异常，大约每1000-1500个新生儿中就有1个。在接受唇腭裂修复的儿童患者中，有效的术后疼痛管理仍然是一个挑战。因此，本系统综述和网络荟萃分析旨在评估神经阻滞在控制唇腭裂患儿术后疼痛方面的有效性，并与其他方法进行比较。方法本综述遵循系统评价和荟萃分析指南的首选报告项目。在多个数据库中进行了全面的检索，包括Embase、MEDLINE、Cochrane和SCOPUS，没有时间限制。结果共纳入8项随机对照试验，550例患者。研究结果表明，与对照组相比，右美托咪定提供更长的神经阻滞持续时间（增量值= 6.33,CI 95%, 1.49: 11.16）。因此，右美托咪定实现更长时间神经阻滞的概率为89.98%。其次是芬太尼和哌替啶。结论本研究支持神经阻滞特别是右美托咪定用于小儿唇腭裂修复术后疼痛管理的有效性和安全性。佐剂增强神经阻滞提供延长的疼痛缓解和减少对阿片类药物的依赖。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.