Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Abstract

BackgroundChildren undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.Patients and methodsPatients (N=50, 3–12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively.ResultsForty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference −1.0, 95% CI −2.0 to −1.0, P=0.001 and median difference −2.0, 95% CI −3.0 to −1.0, P=0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups.ConclusionIntraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.

Gabapentin plus celecoxib as preemptive analgesia in complex spine surgery for improving perioperative patient anxiety and satisfaction, Is it effective? randomized double- blind controlled clinical trial

“…Complex spine surgery can be defined as thoracolumbar spine surgery with instrumentation, laminectomy at three or more levels, or scoliosis surgery to improve longterm pain and quality of life in symptomatic patients with back diseases associated with significant postoperative pain (12). Inadequate treatment of postoperative pain can lead to patient dissatisfaction with the surgical experience and may have adverse psychological consequences; so, an essential part of perioperative care is postoperative pain management (13) . Recently, both preemptive analgesia and multimodal analgesia have been proposed with acceptance in addressing pain management (14) In agreement with our results for preoperative anxiety and postoperative satisfaction scores, Vasigh et al (2016) (6) ( who used the same combination of preemptive gabapentin plus celecoxib in the same doses as us) found that the mean anxiety score in the gabapentin group was significantly lower compared to the placebo and gabapentin plus celecoxib group respectively (p < 0.001, p<0.05) without significant difference between gabapentin group and gabapentin plus celecoxib group and also found patient satisfaction was significantly higher in gabapentin plus celecoxib group compared to the placebo and gabapentin group (p< 0.05).…”

Ultrasound Guided Erector Spinae Plane Catheter Versus Video-Assisted Paravertebral Catheter Placement in Minimally Invasive Thoracic Surgery: Comparing Continuous Infusion Analgesic Techniques on Early Quality of Recovery, Respiratory Function and Chronic Persistent Surgical Pain: Study Protocol for A Double-Blinded Randomised Controlled Trial.

“…24 Pre-emptive administration of these agents is no longer recommended. 25 Opioid use combined with poorly controlled pain scores postoperatively have been identi ed as risk factors associated with opioid misuse during the postoperative period. 26 Due to current public health concerns regarding addiction to prescription opioids administered postoperatively, that there is a real need to direct our focus towards non-opioid based multimodal analgesic strategies such as fascial plane blocks.…”

Effect of video‑assisted thoracoscopic surgery on pain stress indicators NO, IL‑1β and IL‑6 in the treatment of mediastinal tumor in children

“…In this study, children with a VAS score greater than 3 points were treated with 0.15-0.20% ropivacaine (initial dose, 6-10 ml; maintenance dose, 4-6 ml/h; aggressive dose: is 2-4 ml; the lockout time, 20-30 min; and the maximum dose, 12 ml/h). In this study, the analgesic dose was selected in reference to the study of Kim et al (26) who applied this dose in the investigation of children with lower extremity orthopaedic surgery, which significantly reduced the pain of children and has extremely high application value. The VAS score at T 2 was 2.93±0.66 in the observation group and 5.37±0.63 in the control group.…”