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Updated: Aug 1, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Prediction of Early Postoperative Pain in Infants Undergoing Primary Cleft Palate Repair
Geoff Frawley1,2,3, Courtney Wilkes4, Ben Hallett1
1Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Australia.
Insights
Postoperative pain is common in infants after cleft palate repair, affecting 35%. Specific cleft types (Veau 4, Veau 2) and arm splints increase pain risk, guiding better pain management strategies.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Craniofacial Anomalies
Background:
- Effective postoperative pain management is crucial for infants undergoing cleft palate repair.
- Identifying patients at risk can improve clinical communication and care pathways.
Purpose of the Study:
- To identify risk factors for postoperative pain in infants following cleft palate repair.
- To inform strategies for improved pain management and clinical care.
Main Methods:
- Retrospective cohort study of infants (<36 months) undergoing primary cleft palate repair.
- Analysis of perioperative adverse events, including pain, distress, airway obstruction, hypoxemia, and ICU admission.
- Statistical analysis to determine risk factors associated with postoperative pain.
Main Results:
- 35% of 291 infants required opiate intervention for pain within the first hour post-surgery.
- Infants with Veau 4 (RR 1.82) and Veau 2 (RR 1.49) cleft palates had increased risk of postoperative pain compared to Veau 1.
- Bilateral above-elbow arm splints were significantly associated with increased pain (OR 2.23).
Conclusions:
- Postoperative pain requiring intervention is frequent despite multimodal analgesia.
- Infants with specific cleft types (Veau 4, Veau 2) and those using arm splints may need closer pain monitoring.
- Submucous or soft palate repairs might require less perioperative opiate use.
Objective:
Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management.
Design:
A retrospective cohort study was performed in all infants who had undergone cleft palate repair.
Setting:
Tertiary Institutional.
Participants:
Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022.
Intervention:
Requirement for analgesic intervention in the post operative care unit.
Main Outcome Measure:
Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission.
Results:
Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04-3.18 and 1.49, 95%CI 0.96-2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01-5.16).
Conclusions:
Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates.
