Implementation of a Modified Enhanced Recovery Protocol in Cleft Palate Repairs

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Enhanced Recovery After Surgery (ERAS) Protocols

Background:

• Enhanced Recovery after Surgery (ERAS) protocols are established for adults but less defined for pediatric surgical populations.
• Pediatric craniofacial surgery presents unique challenges for pain management and recovery.

Purpose of the Study:

• To evaluate the effectiveness of a modified ERAS protocol in pediatric patients undergoing primary palatoplasty.
• To assess the impact of the protocol on pain control, oral intake, length of stay, and complication rates.

Main Methods:

• A multidisciplinary modified ERAS protocol was implemented, focusing on gabapentinoids, minimal narcotic use, and non-narcotic pain management.
• Fifty pediatric patients undergoing palatoplasty were prospectively enrolled and compared to historical controls.
• Data collected included patient demographics, narcotic usage, length of stay, oral intake, and complications.

Main Results:

• ERAS patients showed significantly increased oral intake normalized per length of stay (22.3 mL/h vs. 15.4 mL/h).
• Total narcotic usage was substantially lower in the ERAS group across all care phases.
• Length of stay decreased by 36.6% (1.16 days vs. 1.83 days) without an increase in complications.

Conclusions:

• A modified ERAS protocol is effective for pediatric palatoplasty, enabling reduced narcotic requirements.
• The protocol successfully enhanced postoperative oral intake and shortened length of stay.
• Implementation of this ERAS protocol in pediatric craniofacial surgery is safe and beneficial.