Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings
Antonio M Melhem1, Elie P Ramly1,2, Omar S Al Abyad1
1Global Smile Foundation, Norwood, USA.
Summary
An enhanced recovery after surgery (ERAS) protocol for cleft lip repair significantly reduced complications and hospital stays. This approach enables faster recovery and earlier discharge for pediatric patients.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Enhanced recovery after surgery (ERAS) protocols
Background:
- Cleft lip is a common congenital craniofacial anomaly.
- Optimizing postoperative care is crucial for patient recovery and reducing complications.
Purpose of the Study:
- To evaluate the effectiveness of a modified Enhanced Recovery After Surgery (ERAS) protocol in pediatric cleft lip repair.
- To assess the impact of ERAS on postoperative complications, recovery time, and hospital discharge.
Main Methods:
- A modified ERAS protocol was implemented, including preoperative education, nutrition screening, pain management (nerve blocks, short-acting narcotics), antibiotics, and early oral feeding.
- The protocol was applied during Global Smile Foundation outreach programs for craniofacial anomalies.
Main Results:
- The study included 126 pediatric patients undergoing cleft lip repair.
- Postoperative complications were minimal, with 2.4% experiencing delayed wound healing and 0.8% having bleeding.
- Hospital stay did not exceed one day, and patients tolerated early oral feeding.
Conclusions:
- The ERAS protocol is highly effective in minimizing discomfort, reducing opioid use, and shortening hospital stays for cleft lip repair.
- ERAS principles are relevant during the COVID-19 pandemic and opioid crisis, and are applicable in resource-limited settings.
