&lt;p&gt;Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study&lt;/p&gt;

AlGhamdi, Faris; Roth, Catherine; Jatana, Kris R.; Elmaraghy, Charles; Rice, Julie; Tobias, Joseph D.; Thung, Arlyne

doi:10.2147/jpr.s281275

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…An appropriate scale is essential for establishing baseline discomfort and measuring the response to treatment. In previous studies, different scales have been used to measure postoperative pain after tonsillectomy in children (1,(17)(18)(19)(20)(21). During the recovery period, children of all ages may not yet be able to express and quantify the degree of their pain; therefore, an observational tool seems more reliable.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double-blinded, placebo-controlled, single dose analgesic study of preoperative intravenous ibuprofen for tonsillectomy in children

et al. 2022

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PurposeTonsillectomy is a recognized treatment for children with tonsil hypertrophy and results in significant postoperative oropharyngeal pain. Fentanyl and other morphine-like analgesics are widely used as perioperative analgesia but are associated with side effects such as vomiting, nausea, and respiratory depression. As the least toxic non-steroidal anti-inflammatory drug, ibuprofen may be effective and safe for pain control after tonsillectomy. We aimed to explore whether the addition of intravenous (IV) ibuprofen administered at induction can reduce the need for early postoperativeanalgesics.Study design and methodsThis randomized, double-blind, controlled clinical trial enrolled 95 pediatric patients who underwent tonsillectomy. Participants aged 6 months to 12 years were randomly assigned to either the experimental and control groups (1:1). The children were premedicated 15 min before surgery with IV ibuprofen 10 mg kg−1 or placebo (normal saline). Pain was scored at 15, 30, and 120 min after extubation, and IV fentanyl (0.5 mcg kg−1) was administered when the Faces, Legs, Activity, Cry, and Consolability (FLACC) Scale was ≥7 and deemed appropriate by the nursing staff in the post-anesthesia care unit (PACU). The visual analog scale was used as a supplementary evaluation for older children (≥7 years old) who were awake and could self-report pain. The primary outcome variable was the number of patients who received postoperative analgesia.ResultsThe requirement for rescue fentanyl was reduced by 18% with the addition of IV ibuprofen (P = 0.043). There were no signficant differences in the amount of fentanyl administered postoperatively (P = 0.127). Compared with the placebo group, the number of children who needed more than one dose of rescue fentanyl decreased in the experimental group, but the differences were not significant (P = 0.056). There were no significant differences between the groups in terms of operative blood loss (P = 0.978), vomiting, or postoperative bleeding (P = 0.474).ConclusionIt is safe to administer IV ibuprofen 15 min before tonsillectomy, and it can significantly reduce the need for rescue fentanyl. IV ibuprofen should be considered as an important part of the multimodal approach for postoperative analgesia in children.Clinical trial registrationChictr.org.cn, identifier: ChiCTR2100044508.

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Section: Discussionmentioning

confidence: 99%

A randomized, double-blinded, placebo-controlled, single dose analgesic study of preoperative intravenous ibuprofen for tonsillectomy in children

et al. 2022

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“…Multiple efforts to minimize complications associated with obesity and opioids, including opioid-sparing anesthetic techniques, are emerging [66]. In one pilot study, Alghamdi et al, with the use of acetaminophen, dexmedetomidine, dextromethorphan, and ketamine, were able to show effective pain management, parental satisfaction, and an absent need for perioperative opioid analgesia in children undergoing adenoidectomy [67]. Likewise, other studies have reported effective postoperative pain control achieved through peripheral nerve catheters with continuous infusion of local anesthetic agents, limiting the need for opioid use and the associated complications [68][69][70][71].…”

Section: Opioid-sparing Techniques In Obese Childrenmentioning

confidence: 99%

Pediatric obesity and perioperative medicine

Mpody

Owusu-Bediako

Raman

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of reviewChildhood obesity is a public health emergency that has reached a pandemic level and imposed a massive economic burden on healthcare systems. Our objective was to provide an update on (1) challenges of obesity definition and classification in the perioperative setting, (2) challenges of perioperative patient positioning and vascular access, (3) perioperative implications of childhood obesity, (3) anesthetic medication dosing and opioid-sparing techniques in obese children, and (4) research gaps in perioperative childhood obesity research including a call to action. Recent findingsDespite the near axiomatic observation that obesity is a pervasive clinical problem with considerable impact on perioperative health, there have only been a handful of research into the many ramifications of childhood obesity in the perioperative setting. A nuanced understanding of the surgical and anesthetic risks associated with obesity is essential to inform patients' perioperative consultation and their parents' counseling, improve preoperative risk mitigation, and improve patients' rescue process when complications occur. SummaryAnesthesiologists and surgeons will continue to be confronted with an unprecedented number of obese or overweight children with a high risk of perioperative complications.

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“…Most of the pilot studies have looked at some combination of oral dextromethorphan, acetaminophen, NSAID's, dexmedetomidine or clonidine, and ketamine. 46 , 47 There needs to be larger pediatric studies to validate the findings of the initial pilot studies and elucidate the best combination and doses of the various non-opioid adjuncts.…”

Section: Postoperative Eventsmentioning

confidence: 99%

Update on the safety of anesthesia in young children presenting for adenotonsillectomy

McGuire

Doyle

2021

World j. otorhinolaryngol.-head neck surg.

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Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients’ families.

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<p>Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study</p>

Cited by 8 publications

References 43 publications

A randomized, double-blinded, placebo-controlled, single dose analgesic study of preoperative intravenous ibuprofen for tonsillectomy in children

A randomized, double-blinded, placebo-controlled, single dose analgesic study of preoperative intravenous ibuprofen for tonsillectomy in children

Pediatric obesity and perioperative medicine

Update on the safety of anesthesia in young children presenting for adenotonsillectomy

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