Epidural analgesia is superior to local infiltration analgesia in children with cerebral palsy undergoing unilateral hip reconstruction

Abstract

Background and purpose — Treatment of postoperative pain in children with cerebral palsy (CP) is a major challenge. We investigated the effect of epidural analgesia, high-volume local infiltration analgesia (LIA), and an approximated placebo control on early postoperative pain in children with CP who were undergoing unilateral hip reconstruction.Patients and methods — Between 2009 and 2014, we included 18 children with CP. The first part of the study was a randomized double-blind trial with allocation to either LIA or placebo for postoperative pain management, in addition to intravenous or oral analgesia. In the second part of the study, the children were consecutively included for postoperative pain management with epidural analgesia in addition to intravenous or oral analgesia. The primary outcome was postoperative pain 4 h postoperatively using 2 pain assessment tools (r-FLACC and VAS-OBS) ranging from 0 to 10. The secondary outcome was opioid consumption over the 21-h study period.Results — The mean level of pain 4 h postoperatively was lower in the epidural group (r-FLACC: 0.7; VAS-OBS: 0.6) than in both the LIA group (r-FLACC: 4.8, p = 0.01; VAS-OBS: 5.2, p = 0.02) and the placebo group (r-FLACC: 5.2, p = 0.01; VAS-OBS: 6.5, p < 0.001). Corrected for body weight, the mean opioid consumption was lower in the epidural group than in the LIA group and the placebo group (both p < 0.001).Interpretation — Epidural analgesia is superior to local infiltration analgesia for early postoperative pain management in children with cerebral palsy who undergo unilateral hip reconstruction.

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

“… 26 In Kjeldgaard Pedersen et al’s study, which tested the efficacy of epidural analgesia and local infiltration analgesia for early postoperative pain control in children undergoing unilateral hip reconstruction, the patients of the epidural group received continuous epidural infusion of local anesthetic during the anesthesia, which was maintained for the first 2–3 days postoperatively. 27 Although direct comparison is not possible, the postoperative r-FLACC pain scores in this study were rather slightly lower than in Kjeldgaard Pedersen et al’s study. Further controlled studies will be needed focusing on this issue.…”

Management of pain in children and adolescents with cerebral palsy: a systematic review

“…Quality assessment of level I to level III studies found ( n =number of studies): strong ( n =2), moderate ( n =12), and weak ( n =8) quality. Adequate conduct and report of appropriate statistical evaluation including power evaluations was described in nine studies . Suitable methods for controlling confounding variables and limiting potential biases were not reported in any studies.…”

“…Management of postoperative pain was assessed after ( n =number of studies): lower limb orthopaedic surgery ( n =12) and selective dorsal rhizotomy surgery ( n =6) …”

“…Child self‐report was employed in four studies . A validated measure was reported in 10 out of 12 studies …”

Epidural bolus versus continuous epidural infusion analgesia on optic nerve sheath diameter in paediatric patients: A prospective, double-blind, randomised trial

“…When possible, regional analgesia should be performed to optimise postoperative pain management 3 . Continuous epidural catheterisation under general anaesthesia has been used to provide sufficient postoperative analgesia in the days following surgery 3,4 , and epidural analgesia is effective for postoperative pain control in paediatric patients [5][6][7][8] .…”