Comparative efficacy of continuous infusion of bupivacaine/fentanyl and ropivacaine/fentanyl for paediatric pain control after the Ravitch procedure and thoracotomy. A prospective randomized study

Abstract

Aims. (1) To compare the efficacy of bupivacaine/fentanyl and ropivacaine/fentanyl for postoperative pain control (2). To identify the predictors of acute post-operative pain at rest, during deep breathing and coughing. Methods. The study was performed in patients aged 6-18 years after thoracic surgery. The subjects were randomized to the bupivacaine 0.125%/fentanyl 5.0 μg/mL (n=46) or ropivacaine 0.2%/fentanyl 5.0 μg/mL (n=48) group; analgesic mixtures were administered through epidural catheter. All the patients received paracetamol and non-steroidal antiinflammatory drugs. The observation period after surgery lasted 72 h. Pain intensity was assessed at rest, during deep breathing and coughing and was based on the Numerical Rating Scale and the FLACC scale (range 0-10). If the pain was above 2/10, the analgesia was modified. Results. Median pain scores at rest (0.4 vs. 0.5), during deep breathing (0.3 vs. 0.3) and coughing (0.6 vs. 0.6) were comparable in BF and RF group. The intensity of pain at rest was associated with the number of drains inserted into the thorax (β=0.39), the number of pain intensity measurements (β=0.36) and the number of nursing interventions undertaken to relieve pain (β=0.16). Pain intensity at rest determined the intensity of pain during deep breathing (β=0.60), which in turn decided on the severity of pain during coughing (β=0.80). The intensity of pain was increased by age. Conclusions. Thoracic epidural bupivacaine/fentanyl provided adequate pain relief and similar analgesia to ropivacaine/fentanyl. The effectiveness of analgesia depended on the number of pain measurements and interventions by nurses to relieve the pain. Trial Registration: ClinicalTrials.gov; Multimodal Analgesia in Children and Adolescents After the Ravitch Procedure and Thoracotomy; NCT03444636;

<p>Knowledge and Attitudes of Ethiopian Nursing Staff Regarding Post-Operative Pain Management: A Cross-Sectional Multicenter Study</p>

“…Optimal postoperative pain management is an integral part of healthcare professional’s (HCP) responsibility, which requires evaluation, treatment and re-evaluation 12. Repeated pain measurements and intervention done by nurses, for instance, results in effectiveness of epidural analgesia in postoperative patients 13. But for effective POP management, HCPs must have adequate knowledge, positive attitude and good skill 14.…”

The Effects of Gabapentin on Post-Operative Pain and Anxiety, Morphine Consumption and Patient Satisfaction in Paediatric Patients Following the Ravitch Procedure—A Randomised, Double-Blind, Placebo-Controlled, Phase 4 Trial

“…The median average pain scores were <1/10, whereas, in adolescents after scoliosis surgery, in the study by Mayell et al [ 22 ], this was 2–7/10 at rest and 4–7/10 during coughing or movement. We believe that adequate pain relief was achieved thanks to the use of preemptive analgesia [ 23 , 24 ], the combination of non-opioid and opioid analgesics, known as multimodal analgesia in the postoperative period [ 25 ], regular pain measurements [ 26 ] according to the three-step method, i.e., at rest, during deep breathing and coughing [ 9 ] and adequate supervision of the implementation of pain relief procedures in clinical practice [ 27 ]. However, the effect of gabapentin on pain scores was medium, with the exception of maximum pain on the day of surgery, which was large.…”

“…Multimodal analgesia regimens can utilise varying combinations of opioid and non-opioid analgesics and regional analgesic techniques [ 6 ]. Thoracic epidural, in many institutions, is the standard of perioperative analgesia in children with chest wall deformity [ 7 , 8 , 9 ]. However, intravenous analgesia may also be an effective pain management option [ 10 ].…”

Predictors of maximal postoperative pain at rest in adult patients undergoing elective surgery – A multicenter observational study

“…This method was described in our studies conducted in patients under 18 years of age after a thoracic surgery – median pain was <1/10. The three‐step method means that nurses are obliged to evaluate postoperative pain according to the NRS scale under dynamic conditions (i.e., at rest, during deep breathing, and coughing) and relieve pain >2/10 by giving painkillers (Tomaszek, Fenikowski, Gawron, & Komotajtys, 2019; Tomaszek, Fenikowski, Komotajtys, & Gawron, 2019).…”