Safety and Efficacy of Liposomal Bupivacaine (Exparel) in Pediatric Patients Undergoing Cleft Lip and Palate Repair: A Retrospective Review

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Cleft lip and palate surgeries are commonly performed due to the high incidence of these congenital malformations in the pediatric population. Optimal pain control in these patients is important in order to initiate early oral feeding, decrease opiate consumption, and minimize hospital length of stay. Exparel (Pacira Pharmaceuticals, Parsippany, NJ, USA) has been shown to provide superior pain control in adult patients, but few studies have described its use in the pediatric population. We aim to demonstrate that Exparel can be safe and effective when applied to cleft lip and palate surgeries in pediatric patients, including infants. Methods: A retrospective case review from a single surgeon was performed at Corewell Health William Beaumont University Hospital (Royal Oak, MI). The review focused on pediatric patients that received Exparel during cleft lip and palate surgery. All patients received both a local regional block and local infiltration at the surgical site. Patients were monitored in the post-anesthesia care unit (PACU) for up to three hours postoperatively. They were discharged home with non-opioid pain medication from the PACU once able to tolerate oral intake, maintain adequate vitals, and appear subjectively comfortable following the procedure. Results: Nineteen patients were included in this review. Nine patients (47.4%) were male and ten (52.6%) were female. The average age of the cohort was 8.3 +/- 2.3 months (range: 4-14 months). Fifteen patients (78.9%) underwent cleft palate surgery, three (15.8%) underwent unilateral cleft lip surgery and one (5.3%) underwent bilateral cleft lip surgery. The average dose of Exparel administered was 1.89 +/- 0.44mL. Seventeen (89.5%) of the patients were discharged home the same day of surgery, while two (10.5%) patients were admitted at request of the family. No patients experienced intraoperative or postoperative adverse reactions and the 30 day readmission rate was 0%. Conclusion: Our study demonstrates that Exparel is safe and effective for use in pediatric patients undergoing cleft lip and palate surgeries. The implementation of this technique in the field of craniofacial surgery has the potential to eliminate the need for postoperative admissions with significant clinical and cost benefit to both patients and healthcare institutions.

Volume

14

Issue

S4

First Page

9

Last Page

9

Comments

Michigan Academy of Plastic Surgeons Annual Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276704.40248.27

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