Infraorbital nerve block for postoperative pain following cleft lip repair in children

dc.contributor.authorFeriani, Gustavo
dc.contributor.authorHatanaka, Eric [UNIFESP]
dc.contributor.authorTorloni, Maria Regina [UNIFESP]
dc.contributor.authorda Silva, Edina M. K. [UNIFESP]
dc.date.accessioned2019-01-21T10:29:58Z
dc.date.available2019-01-21T10:29:58Z
dc.date.issued2016
dc.description.abstractBackground Postoperative pain is a barrier to the quality of paediatric care, the proper management of which is a challenge. Acute postoperative pain often leads to adverse functional and organic consequences that may compromise surgical outcome. Cleft lip is one of the most common craniofacial birth defects and requires surgical correction early in life. As expected after a surgical intervention in such a sensitive and delicate area, the immediate postoperative period of cleft lip repair may be associated with moderate to severe pain. Infraorbital nerve block associated with general anaesthesia has been used to reduce postoperative pain after cleft lip repair. Objectives To assess the effects of infraorbital nerve block for postoperative pain following cleft lip repair in children. Search methods We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, Issue 6, 2015), MEDLINE, EMBASE, and Literatura Latino-Americana e do Caribe em Ciencias da Saude (LILACS) from inception to 17 June 2015. There were no language restrictions. We searched for ongoing trials in the following platforms: the metaRegister of Controlled Trialsen
dc.description.abstractClinicalTrials.gov (the US National Institutes of Health Ongoing Trials Register), and the World Health Organization International Clinical Trials Registry Platform(on 17 June 2015). We checked reference lists of the included studies to identify any additional studies. We contacted specialists in the field and authors of the included trials for unpublished data. Selection criteria We included randomised controlled clinical trials that tested perioperative infraorbital nerve block for cleft lip repair in children, compared with other types of analgesia procedure, no intervention, or placebo (sham nerve block). We considered the type of drug, dosage, and route of administration used in each study. For the purposes of this review, the term 'perioperative' refers to the three phases of surgery, that is preoperative, intraoperative, and postoperative, and commonly includes ward admission, anaesthesia, surgery, and recovery. Data collection and analysis Two review authors (GF and EH) independently identified, screened, and selected the studies, assessed trial quality, and performed data extraction using the Cochrane Pain, Palliative and Supportive Care Review Group criteria. In case of disagreements, a third review author (EMKS) was consulted. We assessed the evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Main results We included eight studies involving 353 children in the review. These studies reported different types of interventions (lignocaine or bupivacaine), observation times, and forms of measuring and describing the outcomes, making it difficult to conduct meta-analyses. In the comparison of infraorbital nerve block versus placebo, there was a large effect in mean postoperative pain scores (our first primary outcome) favouring the intervention group (standardised mean difference (SMD) -3.54, 95% confidence interval (CI) -6.13 to -0.95en
dc.description.abstractvery low-quality evidenceen
dc.description.abstract3 studiesen
dc.description.abstract120 children). Only one study reported the duration of analgesia (in hours) (second primary outcome) with a difference favouring the intervention group (mean difference (MD) 8.26 hours, 95% CI 5.41 to 11.11en
dc.description.abstractvery low-quality evidence) and less supplemental analgesic requirements in the intervention group (risk ratio (RR) 0.05, 95% CI 0.01 to 0.18en
dc.description.abstractlow-quality evidence). In the comparison of infraorbital nerve block versus intravenous analgesia, there was a difference favouring the intervention group in mean postoperative pain scores (SMD -1.50, 95% CI -2.40 to -0.60en
dc.description.abstractvery low-quality evidenceen
dc.description.abstract2 studiesen
dc.description.abstract107 children) and in the time to feeding (MD -9.45 minutes, 95% CI -17.37 to -1.53en
dc.description.abstractmoderate-quality evidenceen
dc.description.abstract2 studiesen
dc.description.abstract128 children). No significant adverse events (third primary outcome) were associated with the intervention, although three studies did not report this outcome. Five out of eight studies found no unwanted side effects after the nerve blocks. Overall, the included studies were at low or unclear risk of bias. The reasons for downgrading the quality of the evidence using GRADE related to the lack of information about randomisation methods and allocation concealment in the studies, very small sample sizes, and heterogeneity of outcome reporting. Authors' conclusions There is low-to very low-quality evidence that infraorbital nerve block with lignocaine or bupivacaine may reduce postoperative pain more than placebo and intravenous analgesia in children undergoing cleft lip repair. Further studies with larger samples are needed. Future studies should standardise the observation time and the instruments used to measure outcomes, and stratify children by age group.en
dc.description.affiliationUniversidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil
dc.description.affiliationCochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
dc.description.affiliationEmergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil
dc.description.affiliationUnifespCochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
dc.description.affiliationUnifespEmergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipNational Institute for Health Research (NIHR)
dc.format.extentCD011131
dc.identifierhttp://dx.doi.org/10.1002/14651858.CD011131.pub2
dc.identifier.citationCochrane Database Of Systematic Reviews. Hoboken, n. 4, p. CD011131, 2016.
dc.identifier.doi10.1002/14651858.CD011131.pub2
dc.identifier.fileWOS000375927100030.pdf
dc.identifier.issn1469-493X
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/49506
dc.identifier.wosWOS:000375927100030
dc.language.isoeng
dc.publisherWiley
dc.relation.ispartofCochrane Database Of Systematic Reviews
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectPediatric-Patientsen
dc.subjectAnalgesiaen
dc.subjectMetaanalysesen
dc.subjectBupivacaineen
dc.subjectInfantsen
dc.subjectTrialsen
dc.subjectReliefen
dc.titleInfraorbital nerve block for postoperative pain following cleft lip repair in childrenen
dc.typeinfo:eu-repo/semantics/review
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