Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children

Guay, Joanne; Suresh, Santhanam; Kopp, Sandra L.; Johnson, Rebecca L.

doi:10.1002/14651858.cd012819.pub2

Cited by 20 publications

(19 citation statements)

References 76 publications

(11 reference statements)

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“…7 When the combination of opioids and local anaesthetics is used in epidural analgesia, it has a significant synergistic effect, which can enhance the analgesic effect, prolong the analgesic time, reduce the concentration and dosage of local anaesthetics, and improve patient satisfaction. 8 However, the combination of opioids and local anaesthetics may be also complicated with many side effects. Previous studies 9,10 have reported that the combined use may cause side effects such as nausea and vomiting, skin itching and urinary retention, which are poorly tolerated by patients.…”

mentioning

confidence: 99%

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Qian

Gao

Liu

et al. 2020

Int. J. Clin. Pract.

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Epidural anaesthesia can provide satisfactory analgesic and muscle relaxation effects, and it has been widely used in lower abdominal and lower limb orthopaedic surgery clinically. 1,2 Analgesic drugs can be given through an epidural catheter after surgery, which is a safe and effective method for treating acute postoperative pain. 3 Studies 4,5 have shown that compared with the use of a single drug for postoperative analgesia, multimodal analgesia with different technologies can reduce the dose of opioids and have better analgesic effects. Ropivacaine is an amide-type local anaesthetic, which has less central nervous system and cardiovascular toxicity, and has better delayed gaps on the sensory and motor nerve block. 6 It's been reported that the use of ropivacaine in the orthopaedic surgery of lower limb can facilitate the recovery of patients. 7 When the combination of opioids and local anaesthetics is used in epidural analgesia, it has a significant synergistic effect, which can enhance the analgesic effect, prolong the analgesic time, reduce the concentration and dosage of local anaesthetics, and improve patient satisfaction. 8 However, the combination of opioids and local anaesthetics may be also complicated with many side effects. Previous studies 9,10 have reported that the combined use may cause side effects such as nausea and vomiting, skin itching and urinary retention, which are poorly tolerated by patients. Therefore, it is necessary to seek a better way of anaesthesia.

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mentioning

confidence: 99%

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Qian

Gao

Liu

et al. 2020

Int. J. Clin. Pract.

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“…The regulatory agencies in France have enforced 'Jardé law,' an improved clinical trial directive that enhances the protection of the rights of trial participants 71 . Clinical trials involve special population groups like the children, pregnant women, and elderly aged, among other vulnerable groups, which may potentially pose ethical and legal obligations (Figure 5) [72][73][74][75][76] .…”

Section: Human Participants In Clinical Trialsmentioning

confidence: 99%

The Current Perspectives in Clinical Research: Computer-Assisted Drug Designing, Ethics, and Good Clinical Practice

et al. 2022

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In the era of emerging microbial and non-communicable diseases and re-emerging microbial infections, the medical fraternity and the public are plagued by under-preparedness. It is evident by the severity of the Coronavirus disease (COVID-19) pandemic that novel microbial diseases are a challenge and are challenging to control. This is mainly attributed to the lack of complete knowledge of the novel microbe’s biology and pathogenesis and the unavailability of therapeutic drugs and vaccines to treat and control the disease. Clinical research is the only answer utilizing which can handle most of these circumstances. In this review, we highlight the importance of computer-assisted drug designing (CADD) and the aspects of molecular docking, molecular superimposition, 3D-pharmacophore technology, ethics, and good clinical practice (GCP) for the development of therapeutic drugs, devices, and vaccines.

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“…Adults (≥ 18 years) who underwent elective cervical or thoracolumbar spine surgery and required hospital admission for at least 24 hours were included. Exclusion criteria included receiving intraoperative intrathecal or postoperative epidural analgesia (previously shown to provide significant improvement in postoperative pain intensity compared with placebo 12,13 ), admission to the intensive care unit, spine surgery for acute trauma, concurrent cervical and thoracolumbar surgeries, more than one surgery performed on the same day, and fewer than 2 postoperative numeric rating scale (NRS) pain evaluations recorded in the first 24 hours. Preemptive analgesia and intraoperative local anesthetic use were not standardized.…”

Section: Entry Criteriamentioning

confidence: 99%

Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

Yang

Riva-Cambrin

Cunningham³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEThirty percent to sixty-four percent of patients experience poorly controlled pain following spine surgery, leading to patient dissatisfaction and poor outcomes. Identification of at-risk patients before surgery could facilitate patient education and personalized clinical care pathways to improve postoperative pain management. Accordingly, the aim of this study was to develop and internally validate a prediction score for poorly controlled postoperative pain in patients undergoing elective spine surgery.METHODSA retrospective cohort study was performed in adult patients (≥ 18 years old) consecutively enrolled in the Canadian Spine Outcomes and Research Network registry. All patients underwent elective cervical or thoracolumbar spine surgery and were admitted to the hospital. Poorly controlled postoperative pain was defined as a mean numeric rating scale score for pain at rest of > 4 during the first 24 hours after surgery. Univariable analysis followed by multivariable logistic regression on 25 candidate variables, selected through a systematic review and expert consensus, was used to develop a prediction model using a random 70% sample of the data. The model was transformed into an eight-tier risk-based score that was further simplified into the three-tier Calgary Postoperative Pain After Spine Surgery (CAPPS) score to maximize clinical utility. The CAPPS score was validated using the remaining 30% of the data.RESULTSOverall, 57% of 1300 spine surgery patients experienced poorly controlled pain during the first 24 hours after surgery. Seven significant variables associated with poor pain control were incorporated into a prediction model: younger age, female sex, preoperative daily use of opioid medication, higher preoperative neck or back pain intensity, higher Patient Health Questionnaire–9 depression score, surgery involving ≥ 3 motion segments, and fusion surgery. Notably, minimally invasive surgery, body mass index, and revision surgery were not associated with poorly controlled pain. The model was discriminative (C-statistic 0.74, 95% CI 0.71–0.77) and calibrated (Hosmer-Lemeshow goodness-of-fit, p = 0.99) at predicting the outcome. Low-, high-, and extreme-risk groups stratified using the CAPPS score had 32%, 63%, and 85% predicted probability of experiencing poorly controlled pain, respectively, which was mirrored closely by the observed incidence of 37%, 62%, and 81% in the validation cohort.CONCLUSIONSInadequate pain control is common after spine surgery. The internally validated CAPPS score based on 7 easily acquired variables accurately predicted the probability of experiencing poorly controlled pain after spine surgery.

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Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children

Abstract: Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children (Review)

Cited by 20 publications

References 76 publications

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

The Current Perspectives in Clinical Research: Computer-Assisted Drug Designing, Ethics, and Good Clinical Practice

Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

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