Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children

Ganesh, Arjunan; Kim, Andrew; Casale, Pasquale; Cucchiaro, Giovanni

doi:10.1213/01.ane.0000252418.05394.28

Cited by 57 publications

(51 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For all the patients undergoing robotic procedures at our institution, we utilize intrathecal opioid injection. We have found that there is decreased length of stay and postoperative pain (47). There are no intravenous rescues in the first 24 hours postoperatively.…”

Section: Postoperative Pain Managementmentioning

confidence: 77%

Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update

Casale

Kojima

2009

Scand J Surg

View full text Add to dashboard Cite

Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcome comparable to the open procedure. However, main drawback has been the relatively steep learning curve for this procedure because of technical difficulties of suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, with the main advantage being simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimentional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, and provides some technical aspects of RAS and a critical summary of current knowledge on its indications and outcome. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgery for children with urological anomalies could be replaced by RAS, which may be established as an alternative minimally invasive surgery in the future.

show abstract

Section: Postoperative Pain Managementmentioning

confidence: 77%

Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update

Casale

Kojima

2009

Scand J Surg

View full text Add to dashboard Cite

show abstract

“…Furthermore, the certainty of intrathecal injection with open catheter placement was considered a significant advantage over peridural infusion. 21 Intrathecally administered opioids are very effective for both acute 4,7,8,17,31 and chronic 23 pain. This is most likely a result of the direct application of morphine close to spinal receptors and within the blood-brain barrier.…”

Section: Discussionmentioning

confidence: 99%

“…At 1, 2, 4, 6,8,10,12,16,20,24,48, and 72 hours the following parameters were documented: Numeric Rating Scale (NRS) score 13 for pain assessment, additional morphine needed, side effects attributable to morphine, respiratory rate, oxygen saturation (SaO 2 ), mean arterial blood pressure (MABP), and heart rate.…”

mentioning

confidence: 99%

Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

Poblete¹,

Konrad²,

Kothbauer

2014

SPI

View full text Add to dashboard Cite

Object The aim of this study was to provide evidence for the effect of intrathecal morphine application after spinal cord tumor resection. Methods Twenty patients participated in a prospective open proof-of-concept study. During dural closure, morphine (7 μg/kg) was injected into the subarachnoid space. All patients were monitored in an intensive care setting postoperatively. Pain, additional opioids given, and vital parameters were recorded. Results Six patients received a mean morphine dose of 365 μg between C-3 and C-7 and 14 patients received a mean dose of 436 μg between T-2 and T-12. In the cervical and thoracic groups, the mean Numeric Rating Scale score was highest upon intensive care unit admission (1.2 and 2.5, respectively) and declined at 12 hours (0.5 and 0.8, respectively). Minimal extra morphine was required. Minor side effects occurred without consequence. Conclusions Intrathecal morphine for postoperative analgesia after resection of cervical and thoracic spinal cord tumors is effective and safe. These preliminary results require confirmation by larger comparative studies and further clinical experience.

show abstract

“…We have found that this results in a decreased length of stay and decreased postoperative pain. [61] There are no intravenous rescues in the first 24 hours postoperatively. Ketorolac is our drug of choice for added pain management.…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Kojima¹,

Khurgin²,

Casale³

2012

Turkish Journal of Urology

Self Cite

View full text Add to dashboard Cite

Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcomes comparable to open procedures. The main drawback has been the relatively steep learning curve for this procedure that is associated with technical difficulties such as suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, mainly the simplification and precision of exposure and suturing. The robotic arms move in real time with an increased degree of freedom and a magnified, 3-dimensional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, provides technical aspects of RAS and offers a critical summary of current knowledge on its indications and outcomes. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgeries for children with urological anomalies could be replaced by RAS and this procedure may be established as an alternative minimally invasive surgery in the future.Key words: Laparoscopy; minimally invasive surgery; pediatrics; robotics; urinary tract reconstruction; urology. ÖZETÇocuklarda nefrektomi, piyeloplasti ve orşiopeksi gibi ürolojik hastalıklar için laparoskopik prosedürlerin, açık prosedürlerle kıyaslanabilir sonuçlar ile birlikte, güvenli ve etkili olduğu kanıtlanmıştır. Bu prosedür-lerin, sütür atma ve anastamoz gibi teknik zorluklarla ilişkili göreceli dik öğrenme eğrisi olması başlıca dezavantaj olmaktadır. Son zamanlarda, robot yardımlı laparoskopik cerrahi (RAS) erişkin ürolojisinde olağanüstü bir popülerlik kazanmıştır ve bütün dünyada giderek artan bir şekilde kabul görmektedir; buna karşın, bir kaç pediatrik üroloji serisi yayınlanmıştır. RAS konvansiyonel laparoskopik cerrahiye kıyasla bir kaç avantaja sahiptir; bunların başlıcaları pozlama ve sütur atmanın kolaylığı ve hassasiyetidir. Robot kollar artmış bir serbestlik derecesinde ve büyütülmüş 3 boyutlu bir bakış açısıyla gerçek zamanlı olarak hareket etmektedir. Bu özellikler RAS'ı pediatrik ürolojik populasyonda kompleks rekonstrüktif cerrahi için ideal yapmaktadır. Bu derleme pediatrik ürolojide RAS'ın rolünü tartışmakta, RAS'ın teknik yönlerini bildirmekte ve endikasyonları ve sonuçları hakkında güncel bilgilerin eleştirel bir özetini sunmaktadır. Ürolojik anomalisi olan çocuklar için açık veya konvansiyonel laparoskopik rekonstrüktif cerrahi şeklinde klasik olarak yapılan hemen hemen tüm operasyonların yerine RAS yapılabilir ve bu prosedür gelecekte alternatif bir minimal invaziv cerrahi olarak yerleşebilir.

show abstract

Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children

Abstract: We conclude that low-dose intrathecal morphine in the pediatric population can be a useful and safe adjunct for postoperative analgesia.

Cited by 57 publications

References 21 publications

Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update

Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update

Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

Robotic-assisted laparoscopic surgery in pediatric urology: an update

Contact Info

Product

Resources

About