The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

Anghelescu, Doralina L.; Ross, Catherine E.; Oakes, Landon; Burgoyne, Laura L.

doi:10.1016/j.jpainsymman.2007.06.010

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…While patients receiving epidural analgesia post-LSS were initially managed in the ICU, they are now safely managed in non-ICU areas with frequent nurse observation and centralized pulse oximeter monitoring. In our experience, the concurrent use of IV opioids and epidural opioids does not increase the risk of respiratory or central nervous system complications (Anghelescu, Ross, Oakes, & Burgoyne, 2008). …”

Section: Discussionmentioning

confidence: 84%

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Anghelescu¹,

Oakes²,

Hankins³

2011

Pain Management Nursing

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A significant proportion of patients report long-term pain that is 5 or above on a 0 to 10 intensity scale after limb-sparing surgery for malignancies of the long bones. Patients experience several distinct types of pain after limb-sparing surgery, which constitute a complex clinical entity of pain post-limb sparing surgery. This retrospective study examined 26 years of experience in a pediatric institution (1981 through 2007) in pain management as far as 6 months after limb-sparing surgery and reviewed the historical evolution of pain interventions. One hundred and fifty patients underwent 151 limb-salvage surgeries for bone cancer of the extremities in this series. Pain treatment increased progressively in complexity. Therapies included opioids, nonsteroidal antiinflammatory drugs, acetaminophen-opioid combinations, postoperative continuous epidural infusion, anticonvulsants and tricyclic antidepressants for neuropathic pain, local anesthetic wound catheters, and continuous peripheral nerve block catheters. Management of pain after limb-sparing surgery has evolved over the 26 years of this review. It presently relies on multiple "layers" of pharmacological and nonpharmacological strategies to address the complex mixed nociceptive and neuropathic mechanisms of pain in this patient population.

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Section: Discussionmentioning

confidence: 84%

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Anghelescu¹,

Oakes²,

Hankins³

2011

Pain Management Nursing

Self Cite

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“…In children with cancer, supplemental IV opioid boluses (either nurse-administered or via PCA) were safely combined with epidural bupivacaine and fentanyl infusion to control postoperative pain. One of 117 patients developed respiratory depression (due to a drugdose error), but patients were closely monitored and had pre-existing tolerance to opioids (Anghelescu et al, 2008 Level IV).…”

Section: Treatment-related Painmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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“…Local anesthetic solutions may be combined with adjuvant medications such as alpha‐2 agonists or opioids. Dexmedetomidine and clonidine have been shown to enhance and prolong analgesia (more so than opioid adjuvants), ultimately allowing a decrease in the local anesthetic dose requirement . To our knowledge, no data are available to support the use of epidural steroid injections in children or adolescents …”

Section: Discussionmentioning

confidence: 99%

Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

2015

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This review discusses the role of interventional procedures in the treatment of chronic pain in children and adolescents. Due to lack of scientific evidence, significant controversy surrounds the utility of invasive techniques for managing pediatric chronic pain states. Interventional procedures are a widely accepted modality for pain management in adults. The use of such techniques in children is supported only by case reports, case series, and very few randomized controlled studies. In addition, the potential for severe complications leaves open a debate on the safety of these invasive procedures, which must be confirmed by more extensive and accurate prospective studies.

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The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

Cited by 7 publications

References 40 publications

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

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