Enhanced Recovery After Cleft Palate Surgery: Protocol Development and Implementation in Outreach Settings

ObjectiveTo describe and demonstrate the effectiveness and reproducibility of a modified enhanced recovery after surgery (ERAS) protocol for patients with cleft palate (CP).DesignProspective cohort study.SettingOutreach Medical Programs, resource-limited settings.PatientsPediatric patients with CP who underwent CP repair.InterventionsModified ERAS protocol.Main Outcome Measure(s)Complication rate, post-operative pain management, time to discharge.Results52 CP repairs done during three outreach medical programs were included in the study. 22 (42.3%) procedures were performed in GYE SEP 2022, 6 (11.5%) procedures in SAL JAN 2023, and 24 (46.2%) in GYE MAR 2023. The mean age was 4.9 years across all programs. 22 (42.4%) patients were between 1 and 3 years of age, 26 (50%) were between 3 and 12 years of age, and 4 (7.6%) were older than 12 years of age. Patients were equally distributed among gender with 26 (50%) being males and 26 (50%) females. A total complication rate of 5.8% was reported. 51 patients were discharged on post-op day one and only one patient was kept for an additional day for monitoring. Four patients required Fentanyl in PACU for post-operative pain, ketamine was used in 1 patient, 7 patients received Dexmedetomidine (Precedex), and ketorolac was used in 16 patientsConclusionsA modified ERAS protocol for CP surgery has been developed and implemented for outreach settings. This approach showed decreased post-operative complications, decreased length of hospital stay, and decreased opioid use while maintaining adequate pain control, establishing early enteral feeding and thus enhancing patient recovery.