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

Abstract

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. 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. 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. 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.