A systematic review of outcomes reported in pediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group

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Background: The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective observational study reported critical events requiring intervention during 35.2% of 6542 anesthetic episodes in 5609 infants up to 60 weeks postmenstrual age. The United Kingdom (UK) was one of 31 participating countries.Methods: Subgroup analysis of UK NECTARINE cases (12.8% of cohort) to identify perioperative critical events that triggered medical interventions. Secondary aims were to describe UK practice, identify factors more commonly associated with critical events, and compare 30-day morbidity and mortality between participating UK and nonUK centers.Results: Seventeen UK centers recruited 722 patients (68.7% male, 36.1% born preterm, and 48.1% congenital anomalies) undergoing anesthesia for 876 surgical or diagnostic procedures at 25-60 weeks postmenstrual age. Repeat anesthesia/ surgery was common: 17.6% patients prior to and 14.4% during the recruitment period. Perioperative critical events triggered interventions in 300/876 (34.3%) cases.Cardiovascular instability (16.9% of cases) and/or reduced oxygenation (11.4%) were more common in younger patients and those with co-morbidities or requiring preoperative intensive support. A higher proportion of UK than nonUK cases were graded as ASA-Physical Status scores >2 or requiring urgent or emergency procedures, and 39% required postoperative intensive care. Thirty-day morbidity (complications in 17.2%) and mortality (8/715, 1.1%) did not differ from nonUK participants. Conclusions:Perioperative critical events and co-morbidities are common in neonates and young infants. Thirty-day morbidity and mortality data did not demonstrate national differences in outcome. Identifying factors associated with increased

Section: Introductionmentioning

confidence: 99%

Perioperative critical events and morbidity associated with anesthesia in early life: Subgroup analysis of United Kingdom participation in the NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective multicenter observational study

Walker

Engelhardt

Ahmad

et al. 2022

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“…Furthermore, in children, assessment of postoperative pain is not standardized despite that pain and analgesic requirement are assessed most frequently in children in published trials. 41 Different pain scales, outcomes, and pain triggers were used in the clinical trials. Establishing standardized core outcomes assessing postoperative pain will improve the consistency among clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the present evidence for the comparison between ESPB and other types of nerve block is limited; thus, additional RCTs are needed. Furthermore, in children, assessment of postoperative pain is not standardized despite that pain and analgesic requirement are assessed most frequently in children in published trials 41 . Different pain scales, outcomes, and pain triggers were used in the clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta‐analysis of randomized controlled trials

Luo

Tong

Yan

et al. 2021

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Background:The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta-analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children.Methods: We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed-or random-effects model, depending on whether the heterogeneity tested by the I 2 statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method.Results: Seven randomized controlled trials involving 379 patients were reviewed.

“…Of the 26 observational pain scales that were used, some were variations of others. (3)(4)(5)(6)(7)(8)(9)(10)(11)(12), CHEOPS (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), CHEOPS used in Taiwan (0-4), and Modified CHEOPS (0-10).…”

Section: Observational Pain Scalesmentioning

confidence: 99%

“…Pain and analgesic requirements are among the most frequently reported outcomes in pediatric acute pain trials. 6 However, the use of many different pain scales in these trials has led to difficulties in comparing results of trials, and the performance of meta-analyses. The Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) statement, published in 2008, 7 aimed to address these issues commissioning two systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Researchers’ choice of pain scales in trials of children undergoing surgery: A cross‐sectional analysis of systematically searched randomized controlled trials and survey of authors

Gerstman

Rolland

Tramèr

et al. 2021

Background: Many pain scales are used post-operatively in pediatric trials, making the comparison of trials, and the pooling of data for meta-analyses difficult. The Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) statement, published in 2008, attempted to address this issue. We aimed to investigate the reasons for authors' choice of pain scales and the potential impact of PedIMMPACT. Methods: We performed a cross-sectional analysis of systematically searched randomized controlled trials testing tramadol in children (up to 16 years) undergoing surgery, published between 2000 and 2020 (9 years prior to and 12 years following the publication of PedIMMPACT).Results: Among 76 trials (6211 children), 49 unique pain scales were used. The choice of the scales was explained in 18 trials (24%); in 13 of them, authors at least partly justified their choice by the fact that the pain scale was validated. In 52 trials (68%), the pain scales were referenced, with a total of 59 unique references, most often to prior studies using the same scale (36%) or to studies validating the chosen scale (31%). Twenty-three trials (30%) provided no explanation nor reference. One single trial referenced PedIMMPACT. There was no evidence of a change in the choice of pain scales after the publication of PedIMMPACT. Conclusions:A large variety of pain scales are still used in pediatric post-operative pain trials 12 years after the publication of PedIMMPACT. Only a minority of trials provided an explanation for their choice of pain scale. The reasons given most often included that the scale was validated or it was justified by a reference to a prior study using that scale. The impact of the publication of the PedIMMPACT seems limited.The ethics of the ongoing usage of large numbers of pain scales in pediatric pain trials must be challenged.