Analgesic and sedative effects of multimodal analgesia in stage of emergence after general anesthesia for cleft lip and/or palate prosthesis

Abstract

To investigate the effects of multimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Fifty-four pediatric patients with ASA I and II cleft lip and/or palate, aged 2-7, undergoing prosthesis were randomly allocated into 2 groups: control group (Group C, n=28) inhaling nitrous oxide/oxygen (50%:50%) and sevoflurane(5%) for general anesthesia, and multimodal group (Group M, n=26), injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen (50%:50%) and sevoflurane (5%). Ventilation was controlled with PCV modal to maintain end-tidal CO2 to 35-45 mmHg. Local anesthesia at the surgical site was facilitated by the surgeon before the beginning of surgery. After intubation, rectal paracetamol was used for Group M (120 mg for 2-4 year-olds and 325 mg for 5-7 year-olds) and fentanyl 0.5 microg/kg was injected for postoperative analgesia 10 min before the end of surgery. An observer who was blinded to the protocol recorded the time from the discontinuation of sevoflurane and nitrous oxide to tracheal extubation, accessed the sedation and pain scale, recorded the time ready for discharge from post-anesthesia care unit (PACU) and the incidence of adverse effects. The time ready for discharge from PACU of Group M was (25+/-4) min, significantly shorter than that of Group C [(32+/-3) min, t=7.426, P<0.01]. The analgesia satisfaction rate of Group M was 69.2% (18/26), significantly higher than that of Group C [25.0%, 7/28, P<0.05]. The severe pain rate of Group M was 7.7%, significantly lower than that of Group C (35.7%, F=5.333, P=0.021). The agitation rate of Group M was 11.5%, significantly lower than that of Group C (39.3%, F=4.571, P=0.033). Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and rectal paracetamol and intravenous fentanyl provides sufficient analgesia, minimizes the incidence of agitation after general anesthesia in cleft lip and/or palate surgery for children, increases the speed of referring patients in PACU, and ensures the safety of the postanaesthetic patients.