Effects of multimodal analgesia on cochlear implantation in children

Abstract

Objective To investigate the effects of multimodal analgesia on cochlear implantation in children. Methods Eighty four child patients [1-6 years, American Society of Anesthesiologists (ASA) grade Ⅰor Ⅱ] scheduled for unilateral cochlear implantation were enrolled. They were randomly divided into three groups (n=28): a patient controlled intravenous analgesia (PCIA) group (group A), a PCIA and ropivacaine wound infiltration group (group B), and a PCIA, ropivacaine wound infiltration and paracetamol suppository group (group C). Both groups B and C received 0.25% ropivacaine (1 ml/kg) for wound infiltration after anesthesia induction. Meanwhile, group C was treated with 30-40 mg/kg paracetamol suppository 15 min before operation. Patients in all groups were given combined intravenous and inhaled anesthesia. Then, the heart rate, mean arterial pressure (MAP), oxygen saturation (SpO2) and postanesthesia care unit (PACU) stay, and adverse reactions were recorded immediately after waking (T0), 4 h after surgery (T1), 8 h after surgery (T2), 12 h after surgery (T3), 24 h after surgery (T4), 36 h after surgery (T5), and 48 h after surgery (T6). The Face, Legs, Activity, Cry and Consolability Scale (FLACC) scores and Ramsay scores were recorded at each time points above. The Pediatric Anesthesia Emergence Delirium (PAED) score was recorded at T0. Results Markedly decreased heart rate and MAP were found in group C at T0 and T1, in comparison with groups A and B (P 0.05). Compared with group A, groups B and C showed remarkable decreases in FLACC score at T0-T6(P 0.05). Conclusions Multimodal analgesia including ropivacaine wound infiltration, anal plug medication of paracetamol suppository and PCIA can improve the effects of postoperative analgesia and decrease the incidence of emergence agitation. Key words: Cochlear implantation; Multimodal analgesia