Narcotic Utilization After Cleft Lip Repair: Does Local Anesthetic Choice Matter?

Objective : To analyze whether the choice of intraoperative local anesthetic for cleft lip repair is associated with the amount of perioperative narcotic utilization. Design : Retrospective cohort study. Setting : Hospitals participating in the Pediatric Health Information System. Patients : Primary cleft lip repairs performed in the United States from 2010 to 2020. Interventions : Local anesthesia injected—treatment with lidocaine alone, bupivacaine alone, or treatment with both agents. Outcome Measures : Perioperative narcotic administration. Results : During the study interval, 8954 patients underwent primary cleft lip repair. Narcotic utilization for unilateral (P <.001) and bilateral (P =.004) cleft lip repair has decreased over the last 5 years. Overall, 21.8% (n = 1950) of infants were administered perioperative narcotics for cleft lip repair, such that 14.3% (n = 1282) required narcotics on POD 0, and 7.2% (n = 647) required narcotics on POD 1. In this study, 36.5% (n = 3269) patients received lidocaine, 22.0% (n = 1966) patients received bupivacaine, and 19.7% (n = 1762) patients received both local anesthetics. Administration of any perioperative narcotic was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P =.001, 17.5% vs 21.7%) or only bupivacaine (P <.001, 17.5% vs 22.9%). Narcotic utilization on the day of surgery was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only lidocaine (P <.001, 11.5% vs 15.1%) or only bupivacaine (P =.004, 11.5% vs 14.6%). Narcotic utilization on the first postoperative day was significantly lower in patients receiving both lidocaine and bupivacaine than those receiving only bupivacaine (P =.009, 5.9% vs 8.1%). Conclusions: In children undergoing cleft lip repair, local anesthetic combination of lidocaine and bupivacaine is associated with decreased perioperative narcotic use compared to lidocaine or bupivacaine alone. [ABSTRACT FROM AUTHOR]

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