Use of Local Anesthesia in Adolescent and Adults Undergoing Cleft Lip Repair or Revision: A Systematic Review.

Objective: This study aims to assess the safety and efficacy of solely using local anesthetics for cleft lip repair and/or revision in adolescent and adult patients.

Design: Systematic review.

Setting: Clinical studies describing the use of local anesthetics in cleft lip repair procedures.

Patients, participants: A literature search was conducted using PubMed, Google Scholar, and Embase following the PRISMA 2025 guidelines. Inclusion criteria were studies focusing exclusively on local anesthetic techniques in adolescent or adult patients undergoing cleft lip procedures. Non-English studies, studies involving patients under the age of 10, or those undergoing cleft palate or other otolaryngological procedures were excluded. Risk of bias was addressed by using a modified Downs and Black checklist.

Interventions: Review of local anesthetic use alone for adult and adolescent patients undergoing cleft lip repair or revision.

Main outcomes: The main studied outcomes were any reported general perioperative complications, the necessity of switching to general anesthesia, patients' self-reported pain during the surgery, wound dehiscence, wound infection, and the need for postoperative narcotics for pain control.

Results: The included studies demonstrated consistent evidence supporting the sole use of local anesthesia for cleft lip repair and revision, with absence of wound dehiscence or infection. Most patients reported minimal to no pain and required no general anesthesia during the procedures.

Conclusions: The current literature supports the safety and efficacy of local anesthesia alone for cleft lip repair and revision procedures. This modality offers a promising approach in resource-limited countries where access to general anesthesia is often limited.