No Pain, All Gain: A Literature Review of Anesthetic Options for Alveolar Bone Grafting in Children With Cleft Lip and Palate.

BACKGROUND

Cleft lip and palate affect 6000 to 8000 children annually in the United States. Alveolar bone grafting (ABG) restores maxillary continuity, facilitates tooth eruption, and closes oronasal fistulae, yet donor-site pain often exceeds graft-site pain. Although multimodal, opioid-sparing analgesia is increasingly used, optimal perioperative pain management remains undefined. This review evaluates current evidence on analgesic strategies for pediatric ABG.

METHODS

A literature review of PubMed, ScienceDirect, and Google Scholar (2010-2025) identified studies addressing perioperative pain management in pediatric ABG. Two independent reviewers screened studies and extracted data on study design, analgesic interventions, and pain-related outcomes.

RESULTS

Of 407 records identified, 14 studies met the inclusion criteria. Study designs included retrospective cohorts (57%), systematic reviews (14%), randomized prospective studies (14%), randomized controlled trials (7%), and quasi-experimental studies (7%). Pediatric cohorts ranged from 3 to 18 years. Over 90% used local or regional analgesia. Continuous bupivacaine or ropivacaine infusions (43%) produced the lowest pain scores, the longest analgesic duration (8-12 h), and 60% to 80% reductions in opioid use. Liposomal bupivacaine, regional nerve blocks, and ERAS pathways consistently outperformed single-dose infiltration. Continuous infusions and ERAS protocols reduced length of stay from 0.5 to 1.0 days, enabled up to 80% same-day discharge, and lowered costs by ∼40% to 45%. Adverse events were infrequent and self-limited.

CONCLUSION

Multimodal analgesic strategies-particularly regional anesthesia and continuous local anesthetic delivery-effectively improve pain control, reduce opioid use, and enhance perioperative outcomes in pediatric ABG. However, heterogeneity in pain assessment and limited comparative data underscore the need for standardized outcomes and targeted subgroup analyses.