Open transumbilical pyloromyotomy: is it more painful than the laparoscopic approach?

Lemoine, Caroline; Paris, Catherine; Morris, Mélanie; Vali, Kaveh; Beaunoyer, Mona; Aspirot, Ann

doi:10.1016/j.jpedsurg.2011.02.019

Cited by 18 publications

(11 citation statements)

References 14 publications

(17 reference statements)

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“…15 Similarly, a Canadian comparison of laparoscopic versus open pyloromyotomy in 38 infants reported very low rates of postoperative opioid use in either group (0% vs 5%, respectively). 16 These data suggest that opioids may not be needed for otherwise healthy infants undergoing pyloromyotomy. Our findings support this argument, as we found that most infants did not receive opioids postoperatively, with the most recent year of data (2015) showing 18 hospitals avoided postoperative opioids altogether.…”

Section: Discussionmentioning

confidence: 96%

“…12e14 In fact, previous data suggest that adequate pain control can be achieved with nonopioid modalities in most patients undergoing pyloromyotomy. 15,16 Currently, there are no national data on the use of opioids for infants requiring a pyloromyotomy. Infants undergoing pyloromyotomy are typically healthy, thus providing a relatively uniform clinical population in which to explore variations in perioperative opioid use and its impact on clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

McLaughlin

Squillaro

Ourshaliman

et al. 2019

Clinical Therapeutics

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

McLaughlin

Squillaro

Ourshaliman

et al. 2019

Clinical Therapeutics

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“…2,7 Laparoscopic pyloromyotomy may be associated with less postoperative pain and a slightly shorter time to full feeds. 1,8 The duration of surgery and anaesthesia is similar for laparoscopic and open pyloromyotomy. 7…”

Section: Surgerymentioning

confidence: 99%

Anaesthesia for pyloromyotomy

Craig

Deeley

2018

BJA Education

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By reading this article you should be able to:Describe the electrolyte and acid-base abnormalities associated with infantile hypertrophic pyloric stenosis. Explain why these electrolyte and acid-base abnormalities need to be corrected before surgery. Describe the technique for ultrasound examination of the gastric antrum and qualitative assessment of stomach contents before induction of anaesthesia for pyloromyotomy. Discuss the options for induction of anaesthesia including choice of drugs and techniques.Pyloric stenosis is the result of hypertrophy of the smooth muscle of the pylorus, which forms the gastric outlet. Its aetiology is uncertain, although a number of environmental and hereditary contributory factors have been identified. The reported incidence varies between 0.9 and 5.1 per 1000 live births. 1 In England and Wales it is 1.5 per 1000 live births and has remained static in recent years. 2 The risk of the disease is four to five times higher in boys than girls. 3 There is a decline in risk with increasing birth order with an odds ratio of 1.9 for first-born children. 3 The genetic element is evidenced with higher rates of concordance in monozygotic than dizygotic twins and a number of susceptibility loci have been identified.Babies with infantile hypertrophic pyloric stenosis present most commonly in the 2nd and 3rd months of life. 2 However, a recent review of surgical outcomes for 9686 infants who underwent pyloromyotomy in England over a 10-year period, found that 30% of patients were aged 7e28 days at the time of surgery. 2 The classic presentation is projectile vomiting of non-bilious stomach contents, loss of weight or failure to gain weight (crossing centiles on the growth chart), and dehydration. Abdominal examination may reveal a palpable 'olive'; however, modern developments mean that the majority of patients are being diagnosed earlier with ultrasound and this physical finding is becoming less common. Pathophysiology and electrolyte changesVomiting is the principal symptom of pyloric stenosis, classically described as being projectile in nature. The vomitus in pyloric stenosis consists of gastric secretions. These secretions are high in hydrogen and chloride ions with some sodium and potassium, all of which are lost along with water. The electrolyte losses result in a hypokalaemic, hypochloraemic metabolic alkalosis. The water loss causes dehydration and a reduction in plasma volume; this results in the secretion of aldosterone. Aldosterone causes sodium and water retention Key pointsVomiting results in hypochloraemic, hypokalaemic metabolic alkalosis and dehydration; these must be corrected before general anaesthesia and surgery. The stomach should be emptied using a nasogastric or orogastric tube before induction of anaesthesia. Ultrasound can be used to identify fluid in the gastric antrum. Ensuring adequate depth of anaesthesia with complete neuromuscular block before laryngoscopy minimises the risk of regurgitation and pulmonary aspiration. Options for analgesia include rectus sheath ...

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“…Minimally invasive surgery does not always result in improved pain control with the need for fewer analgesic agents. Lemoine et al 38 evaluated the differences in postoperative pain between infants who underwent either open or laparoscopic pyloromyotomy and they were unable to document relevant differences. With the use of a case–control design, Ceelie et al 39 also documented that minimal access surgery for repair of esophageal atresia or congenital diaphragmatic hernia was not associated with fewer cumulative opioid doses following surgery.…”

Section: Locoregional Anesthesia and Minimally Invasive Techniquesmentioning

confidence: 99%

Pharmacological treatment of neonatal pain: In search of a new equipoise

Allegaert

Tibboel

Anker

2013

Seminars in Fetal and Neonatal Medicine

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SUMMARY Inadequate management of pain in early human life contributes to impaired neurodevelopmental outcome and alters pain thresholds, pain or stress-related behavior and physiological responses. However, there are also emerging animal experimental data on the impact of exposure to analgo-sedatives on the incidence and extent of neuro-apoptosis. Since this association has also been suggested in humans, the pharmacological treatment of neonatal pain is in search of a new equipoise since these ‘conflicting’ observations are the main drivers to further reconsider our current treatment regimens. This review focuses on new data concerning clinical pharmacology of morphine, followed by data on more recently introduced opioids like remifentanil and tramadol, locoregional anesthesia and minimally invasive techniques in neonates, and finally with data on intravenous paracetamol. Since the available data are still incomplete, priorities for both clinical management and future research will be proposed.

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Open transumbilical pyloromyotomy: is it more painful than the laparoscopic approach?

Cited by 18 publications

References 14 publications

The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

The Association Between Opioid Use and Outcomes in Infants Undergoing Pyloromyotomy

Anaesthesia for pyloromyotomy

Pharmacological treatment of neonatal pain: In search of a new equipoise

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