Acute pain such as
postoperative pain during infancy was ignored approximately three decades ago due to biases and misconceptions regarding the maturity of the infant's developing nervous system, their inability to verbally report
pain, and their perceived inability to remember
pain. More recently, these misconceptions are rarely acknowledged due to enhanced understanding of the developmental neurobiology of infant
pain pathways and supraspinal processing.
Cleft lip and palate is one of the most common
congenital abnormalities requiring surgical treatment in children and is associated with intense
postoperative pain. The
pain management gets further complicated due to association with postsurgical difficult airway and other congenital anomalies. Orofacial blocks like infraorbital, external nasal, greater/lesser palatine, and nasopalatine
nerve blocks have been successively used either alone or in combinations to reduce the
postoperative pain. Since in pediatric population,
regional anesthesia is essentially performed under
general anesthesia, association of these two techniques has dramatically cut down the risks of both procedures particularly those associated with the use of
opioids and nonsteroidal anti-inflammatory drugs. Definitive guidelines for
postoperative pain management in these patients have not yet been developed. Incorporation of multimodal approach as an institutional protocol can help minimize the
confusion around this topic.