{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:40:31Z","timestamp":1769521231893,"version":"3.49.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Side effects of opioid pain management after surgical repair of cleft lips are numerous and affect postoperative course. We compared opioid versus opioid-free pain management regimens for infants who underwent cleft lip repair to evaluate the impact on postoperative recovery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Cleft lip repairs at our institution from December 2016 to February 2021 were retrospectively reviewed, comparing patients who received opioids to patients receiving a nonopioid pain control regimen. Data collected include length of stay, oral morphine equivalents (OME) received on day of surgery (DOS)\/postoperative day (POD) 1, time to and volume of first oral feed, and Face\/Legs\/Activity\/Cry\/Consolability (FLACC) scores.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Seventy-three infants were included (47 opioid and 26 nonopioid). The opioid group received average 1.75\u2009mg OME on DOS and 1.04\u2009mg OME on POD1. Average DOS FLACC scores were similar between groups [1.57\u2005\u00b1\u20051.18 nonopioid versus 1.76\u2005\u00b1\u20050.94 (SD) opioid; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.46]. Average POD1 FLACC scores were significantly lower for the nonopioid group (0.73\u2005\u00b1\u20051.05 versus 1.35\u2005\u00b1\u20051.06; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.022). Median time to first PO (min) was similar [178 (interquartile range [IQR] 66\u2013411) opioid versus 147 (IQR 93\u2013351) nonopioid; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.65]. Median volume of first feed (mL) was twice as high for the nonopioid group [90 (IQR 58\u2013120) versus 45 (IQR 30\u201360); <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003].<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Nonopioid postoperative pain management was more effective than opioids for pain management in infants after cleft lip repair, as evidenced by FLACC scores and increased volume of the first oral feed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/gox.0000000000005259","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T12:00:35Z","timestamp":1694174435000},"page":"e5259","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Opioid-free Pain Management after Cleft Lip Repair"],"prefix":"10.1097","volume":"11","author":[{"given":"Annie","family":"Do","sequence":"first","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eve","family":"Rorison","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Borucki","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail S.","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason H.","family":"Pomerantz","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William Y.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California San Francisco; San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2023,9]]},"reference":[{"key":"R1-20240917","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.fsc.2014.07.002","article-title":"Cleft lip and palate.","volume":"22","author":"Crockett","year":"2014","journal-title":"Facial Plast Surg Clin North 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multidisciplinary quality improvement effort to reduce perioperative opioid use in patients undergoing cleft surgery.","volume":"145","author":"Lee","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"R6-20240917","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1177\/1055665621990163","article-title":"Opioid prescribing practices in cleft lip and cleft palate reconstruction.","volume":"58","author":"Falola","year":"2021","journal-title":"Cleft Palate Craniofac J"},{"key":"R7-20240917","doi-asserted-by":"crossref","first-page":"109","DOI":"10.36076\/ppj.2014\/17\/109","article-title":"Long-term neuropsychological effects of opioid use in children: a descriptive literature review.","volume":"17","author":"Jain","year":"2014","journal-title":"Pain Physician"},{"key":"R8-20240917","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.4103\/1658-354X.144085","article-title":"Neonatal pain 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efficacy of paracetamol and diclofenac in children receiving PCA morphine.","volume":"82","author":"Morton","year":"1999","journal-title":"Br J Anaesth"},{"key":"R16-20240917","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0966-6532(98)00052-3","article-title":"Pain management after ambulatory surgery.","volume":"7","author":"Joshi","year":"1999","journal-title":"Ambul Surg"},{"key":"R17-20240917","first-page":"1048","article-title":"The value of \u201cmultimodal\u201d or \u201cbalanced analgesia\u201d in postoperative pain treatment.","volume":"77","author":"Kehlet","year":"1993","journal-title":"Anesth Analg"},{"key":"R18-20240917","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1055\/s-0039-1697220","article-title":"Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries.","volume":"37","author":"Gaonkar","year":"2004","journal-title":"Indian J Plast 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