Efficiency of Post-Operative Pain Management in Infants undergoing Cleft Lip and Plate Repairs: A Study using the FLACC Scale

Abstract

Background Post-operative pain relief in cleft surgery should be efficient and effective. The Face, Leg, Activity, Cry and Consolability (FLACC) scale is a validated tool for post-operative pain assessment in patients who cannot express themselves verbally. The objective of this study was to assess the effectiveness of the analgesic protocol practiced at the Dental Hospital Peradeniya, using FLACC scale during the first 24 hours following cleft surgery. Methods and material Sample included 193 patients who underwent primary repair of cleft lip and palate. They were given paracetamol two hours before surgery and 0.1mg/kg intravenous morphine during surgery. Infra-orbital nerve blocks for cleft lip surgeries, greater palatine nerve blocks for cleft palate surgeries and rectal diclofenac suppository (1.5 mg/kg) if above six months of age were added. The surgical site was infiltrated with 1% lignocaine in adrenaline. Oral paracetamol was used post-operatively. Cuddling, carrying, lullaby singing and nursing by mother was used as non-pharmacological strategies in the ward. Pain assessment was done at 5 min after recovery from anaesthesia and then at 30 minutes, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 5 hours and 6 hours after recovery, and then at 8 am and 12 noon on the day following surgery using the FLACC scale. Results The number of patients with severe to profound pain reduced gradually following recovery, except for a minor resurgence of pain at 2.5 hours. At the end of first 24 hours, 92.7% of patients had no pain according to the FLACC scale while only less than 1% had severe pain. Conclusion The combined protocol of pharmacological and non-pharmacological strategies used at the Cleft Centre was highly effective for relief of post-operative pain in cleft surgeries.