Our Summary

This research paper discusses a new protocol for treating patients with cleft lip, a common birth defect affecting the upper lip. The protocol is known as Enhanced Recovery After Surgery (ERAS) and it includes steps like patient education before the surgery, nutrition checks, quitting smoking if applicable, use of local anesthesia, pain management after surgery, short-term use of strong painkillers, antibiotics, use of elbow restraints to prevent the patient from touching the surgical area, early feeding and drinking after surgery, and planning for discharge.

The Global Smile Foundation implemented this protocol on 126 patients, most of them infants, between April 2019 and March 2020. Only three patients had issues with wound healing and one had bleeding after surgery. No deaths were reported, patients were able to leave the hospital within a day after the surgery, and they could eat and drink normally at the time of discharge.

The study concludes that this new protocol is very effective in reducing discomfort after surgery, reducing the use of strong painkillers, shortening the hospital stay, and enabling patients to eat and drink normally sooner. The protocol is particularly relevant during the COVID-19 pandemic and ongoing opioid crisis, and it can be used even in settings where resources are limited.

FAQs

  1. What is the Enhanced Recovery After Surgery (ERAS) protocol for cleft lip repair?
  2. How effective has the ERAS protocol been in treating patients with cleft lip according to the study by the Global Smile Foundation?
  3. How does the ERAS protocol for cleft lip repair help in the context of the COVID-19 pandemic and the ongoing opioid crisis?

Doctor’s Tip

A doctor might tell a patient undergoing cleft lip repair to follow the ERAS protocol for a quicker and smoother recovery. This includes following pre-surgery instructions, quitting smoking, managing pain effectively, and maintaining good nutrition. By following this protocol, patients can expect a faster recovery, reduced discomfort, and an overall better surgical outcome.

Suitable For

Typically, patients recommended for cleft lip repair are infants and children born with a cleft lip deformity. Cleft lip repair is usually recommended within the first few months of life to improve feeding, speech development, and overall appearance. In some cases, adults with untreated cleft lip deformities may also be recommended for repair surgery to improve their quality of life and self-esteem.

Timeline

Before cleft lip repair:

  1. Patient is diagnosed with cleft lip during prenatal ultrasound or after birth.
  2. Patient and their family receive counseling and education about the condition.
  3. Patient undergoes pre-surgery evaluations including nutrition checks and quitting smoking if applicable.

After cleft lip repair:

  1. Patient undergoes surgery to repair the cleft lip.
  2. Patient is given local anesthesia during the surgery.
  3. Patient is managed for pain post-surgery with strong painkillers and antibiotics.
  4. Patient may have elbow restraints to prevent them from touching the surgical area.
  5. Patient is allowed to start feeding and drinking soon after the surgery.
  6. Patient is discharged from the hospital within a day after the surgery.
  7. Patient can eat and drink normally at the time of discharge.

Overall, the patient undergoes a smooth and efficient process before and after cleft lip repair, leading to a successful outcome with minimal discomfort and a quick recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft lip repair using the ERAS protocol may include:

  1. Can you explain the Enhanced Recovery After Surgery (ERAS) protocol and how it differs from traditional cleft lip repair procedures?
  2. How will the ERAS protocol affect my overall recovery process and timeline?
  3. What specific steps will be taken to ensure my comfort and pain management after surgery?
  4. How soon after the surgery will I be able to eat and drink normally?
  5. Will there be any restrictions or precautions I need to follow post-surgery to promote optimal healing?
  6. How will the use of local anesthesia and short-term painkillers impact my recovery compared to stronger pain medications?
  7. What measures will be in place to prevent infection and promote wound healing?
  8. Will there be any follow-up appointments or ongoing care needed after the surgery?
  9. How has the implementation of the ERAS protocol improved outcomes for patients with cleft lip repair?
  10. Are there any potential risks or complications associated with the ERAS protocol that I should be aware of?

Reference

Authors: Melhem AM, Ramly EP, Al Abyad OS, Chahine EM, Teng S, Vyas RM, Hamdan US. Journal: Cleft Palate Craniofac J. 2023 Jun;60(6):724-733. doi: 10.1177/10556656221078744. Epub 2022 Feb 15. PMID: 35167405