Do Patients With Cleft Lip and/or Cleft Palate Require More Postoperative Opioids Following Le Fort I Osteotomy?

Le Fort I (LFI) osteotomies in patients with cleft lip and/or palate (CL/P) present unique challenges. It is unclear if these patients require distinct postoperative pain management.

The purpose of this study was to measure and compare postoperative opioid consumption between patients with and without CL/P undergoing LFI osteotomies.

This retrospective cohort study included patients who underwent LFI osteotomies at Boston Children's Hospital (2015 to 2024). Patients with chronic pain, psychiatric disorder, or developmental delay were excluded.

The predictor variable was CL/P status coded as CL/P present or absent.

The primary outcome variable was postoperative opioid consumption in morphine milligram equivalents while inpatient. Secondary outcome variables included any opioid use (yes/no) and opioid delivery route (intravenous/oral).

Covariates included sex, age, magnitude of maxillary advancement, procedure length, ancillary procedures, length of hospital stay, surgeon, and postoperative nausea and/or vomiting.

χ² tests, nonparametric tests of medians, independent sample t tests, and the Mann-Whitney U test were used to evaluate sample characteristics. A generalized linear model with a Gamma distribution and log link was used to create an adjusted model. P values <.05 were statistically significant.

A total of 399 subjects (53.9% [n = 215] males) were included with a median age of 19.09 (interquartile range: 17.65 to 20.65) years. The cohort consisted of 44.9% (n = 179) with a history of CL/P, compared to 55.1% (n = 220) without CL/P. Subjects with CL/P required a smaller median dose (milligram morphine equivalents) of total postoperative opioids compared to those without CL/P (6.56 [1.20 to 22.40] vs 13.80 [2.50 to 34.61], P < .001) despite subjects with CL/P having a greater mean magnitude of maxillary advancement (6.79 ± 2.49 vs 5.73 ± 2.22, P < .001). After adjusting for sex, age, procedure length, magnitude of maxillary advancement, ancillary procedures, length of stay, surgeon, and postoperative nausea and/or vomiting, subjects with CL/P displayed a 33% reduction in total opioid requirement compared to subjects without CL/P (mean ratio: 0.67 [0.51 to 0.87], P = .003).

Patients with CL/P may require fewer opioid analgesics during inpatient recovery following LFI osteotomy compared to patients without CL/P.