A retrospective comparison of thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum

Abstract

Implementation of a standardized comprehensive multimodal analgesic protocol following minimally invasive repair of pectus excavatum resulted in equivalent analgesia with a modest reduction in length of stay when compared to thoracic epidural. We did not observe an opioid sparing effect in our thoracic epidural which may reflect technique variability.

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…At our institution, opioids form the basis of the perioperative analgesic regimen for children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, and a multimodal approach is typically introduced only when postoperative opioid requirements increase. However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies . Of particular interest in this patient population may be the early inclusion of anti‐hyperalgesic agents such as methadone, ketamine, and dexmedetomidine.…”

“…Oral gabapentinoids may also be introduced when appropriate . As demonstrated by other studies, the implementation of a standardized multimodal analgesic protocol which is managed by a dedicated Pain Service may be necessary to attain the full benefit of this approach …”

“…However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies. [16][17][18][19] Of particular interest in this patient population may be the early inclusion of anti-hyperalgesic agents such as methadone, ketamine, and dexmedetomidine. There is evidence to suggest that NMDA receptor antagonism by these agents may prevent opioid-induced hyperalgesia and reduce acute tolerance to the analgesic effects of opioids.…”

“…24 As demonstrated by other studies, the implementation of a standardized multimodal analgesic protocol which is managed by a dedicated Pain Service may be necessary to attain the full benefit of this approach. 17 In addition to multimodal analgesia, the early introduction of physical, occupational and child-life specialists may aid in reducing the dependence on analgesics for pain control. This multidisciplinary approach to pain control has been shown to be superior to singlediscipline pain management.…”

Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center

“…[12][13][14] In recent years various medical interventions have been successfully carried out. [15][16][17][18][19][20][21][22] Medical intervention continues to be developed in order to effectively eliminate pain with minimal risks. Several medical intervention techniques with invasive procedures for pain have also been performed, such as hydrodisectomy with ultrasound guidance.…”