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

Abstract

Objective: To evaluate the safety and effectiveness of lipsomal bupivacaine (Exparel) in reducing opioid use and facilitating same-day discharge in pediatric patients under age six undergoing cleft lip palate surgery. Design: Retrospective chart review. Setting: Corewell Health East William Beaumont University Hospital, Royal Oak, Michigan. Patients, Participants: Nineteen pediatric patients under age six who underwent primary cleft lip or palate repair by a single reconstructive plastic surgeon between February 2023 and February 2025. Interventions: All patients received intraoperative administration of weight-based Exparel (4 mg/kg) via peripheral nerve blocks (greater or infraorbital) and direct surgical site infiltration. Main Outcome Measure(s): Same day discharge rate, postoperative opioid requirement, and 30-day adverse events including readmission or pain-related follow-up. Results: Seventeen patients (89.5%) were discharged home on the day of surgery. No patients required postoperative opioid prescriptions and no readmissions or pain-related follow-ups occurred within 30 days. There were no immediate or delayed adverse reactions attributed to Exparel. Conclusions: Lipsomal bupivacaine appears to be a safe adjunct for postoperative pain management in cleft lip and palate surgery for pediatric patients under age six. Its use was associated with high same-day discharge rates, complete avoidance of postoperative opioids, and no adverse outcomes. These findings support further prospective studies to confirm Exparel's role in enhancing recovery and minimizing opioid exposure in pediatric craniofacial surgery.