Does use of bupivacaine-soaked pledgets aid in the care of postoperative cleft palate patients?

Abstract

Bupivacaine-soaked pledgets have been shown to decrease postoperative pain in patients requiring iliac crest harvesting, even with the use of field blocks. This finding was applied to cleft palate repair. A retrospective review of cleft palate cases over a 1-year period, 6 months with hemostatic pledgets, and 6 months with bupivacaine-soaked hemostatic pledgets. Demographic data, postoperative analgesic use, time to feeding and discharge, and complications were gathered. The study was limited to isolated primary palate repair in non-syndromic patients. There were a total of 85 total primary palate patients. Exclusion of patients with concomitant procedures and syndromic patients left 18 patients in the control group and 16 patients in the bupivacaine group. Morphine (0.26 v 0.22 mg/kg), acetaminophen (9.5 v 6.4 mg/kg) and acetaminophen with codeine (0.86 v 0.75 mg/kg) were not significantly different. Time to first significant oral feeding was 12.4 v 11.7 hrs, time to discharge 27 v 31 hours. There were no postoperative hemorrhages or infection. There was no significant decrease in postoperative analgesic use, time to first significant oral intake feeding or discharge. There was no post operative bleeding or infection. Bupivicaine soaked pledgets do not significantly decrease postoperative analgesic use or shorten time to first or sustained feeding. However the use of hemostatic pledgets may decrease postoperative infection and bleeding rates.