Analgesia In Children Research Articles

A randomized clinical trial of intranasal dexmedetomidine versus inhaled nitrous oxide for procedural sedation and analgesia in children

BackgroundProcedural sedation and analgesia is an important part of pediatric emergency care, safe and clinically useful alternatives for adequate management are necessary. The objective of this clinical trial was to evaluate the non-inferiority of intranasal dexmedetomidine to nitrous oxide with respect to analgesia for a painful procedure in children 3–15 years of age.MethodsThis prospective, equally randomized, open-label, non-inferiority trial was conducted at a Pediatric Emergency Department. Previously healthy children 3–15 years of age, with an extremity fracture or luxation or a burn and requiring procedural sedation and analgesia were eligible. Patients were randomized to receive either intranasal dexmedetomidine or inhaled nitrous oxide. The primary outcome measure was highest pain level during the procedure, assessed with Face, Legs, Activity, Cry, Consolability scale (FLACC). Mann-Whitney U test (continuous variables) and Fisher’s test (categorical variables) were used for statistical analysis.ResultsThe highest FLACC was median 4 (IQR 3–6) with intranasal dexmedetomidine and median 4 (IQR 2–6) with nitrous oxide. The median of the difference between samples from each group for FLACC was 0 with 95%CI (0–1), thus intranasal dexmedetomidine was not inferior to nitrous oxide with respect to the level of pain during the procedure. The same method for procedural sedation and analgesia would be accepted by 52/74 (82.5%) children and 65/74 (91.5%) parents in the intranasal dexmedetomidine group respectively 59/74 (88.1%) versus 70/74 (94.6%) with nitrous oxide. No serious adverse events were reported.ConclusionsThe results of this trial support that intranasal dexmedetomidine is not inferior to 50% nitrous oxide in providing analgesia for a painful procedure in children 3–15 years of age and can be considered as an alternative to 50% nitrous oxide for procedural sedation and analgesia.Trial registrationEudraCT 201,600,377,317, April 20, 2017. https://eudract.ema.europa.eu/.

Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial

IntroductionThis study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing...

At-home Administration of Opioid Analgesia in Children After Reduction of Forearm Fracture.

Controversy exists surrounding which agents best provide analgesia in children with fractures. Prior studies have demonstrated that ED visits for fracture-related pain have the highest rates of opioid prescribing. Studies have also found that NSAIDs are equivalent at controlling acute fracture-related pain. In a time when one must balance the risk of inadequate pain control with potential opioid misuse, providers have little data to guide them in terms of the best recommendations for adequate pain control at home. This prospective observational study investigates parental pain management practices after ED discharge for children who underwent a forearm fracture reduction. Surveys filled out by parents were used to gather data on the proportion of children discharged with an opioid prescription, the number of doses of opioid that were administered after discharge, and parental satisfaction with their child's pain control. We analyzed data for 61 patients who completed the postdischarge survey. Of these, 62% received a prescription for oxycodone at discharge, and 50% used at least 1 dose of oxycodone at home. The median number of doses administered at home, 1.5 (IQR, 0-3), was significantly lower than the number of doses of oxycodone prescribed, 10 (IQR, 5-12) (P < 0.001). Parents reported a high level of satisfaction with the medications received at discharge with nearly all ranging between 4 (satisfied) and 5 (very satisfied) (median, 5; IQR, 4-5). No significant difference was detected in the satisfaction between families who received a prescription for oxycodone at discharge (median, 5; IQR, 4-5) and those who did not (median, 5; IQR, 4-5) (P = 0.28). We observed a large range in the number of doses of oxycodone prescribed at discharge and a significant difference between the number of doses being prescribed and those being used by families. A prescription of 2 doses of oxycodone would be sufficient to treat postreduction pain in the majority of children.

Susceptibility of two different PCA pumps to inaccurate delivery associated with pole position at low flow-rates in a pediatric setting - an experimental study.

Vertical displacement of infusion pumps used in patient-controlled analgesia can cause irregularities in drug delivery and is especially crucial at low flow rates, which are commonly used in pediatrics. There is only scarce data available regarding the extent of these inaccuracies. The current in vitro study therefore aimed at a comparison of the performance of two commonly used PCA pumps at different pole positions due to vertical displacement. The Syramed® µSP6000 Chroma syringe infusion pump featuring a stepper motor drive was compared to the CADD®-Solis pump utilizing a linear peristaltic pump system at two different flow rates (0.3ml/h and 1ml/h) and three different levels of height (0, + 50 and - 50cm). Flow patterns and delivered volumes were measured after every change in position and infusion boluses, retrograde aspiration volumes and zero-drug delivery time were calculated. The Syramed® pump was more susceptible to vertical displacement than the CADD®-Solis pump and showed overall greater inaccuracies in the delivered volumes as well as higher infusion boluses, retrograde aspiration volumes and zero-drug delivery time at both flow rates. The observed differences between the pumps might be explained by the higher compliance of this syringe pump and the diverse working mechanisms. Overall, the CADD®-Solis pump might be considered a preferable option for patient-controlled analgesia in children. It is nonetheless essential for medical staff to be aware of the effects of vertical displacement of PCA pumps and to minimize these displacements as much as possible.

Comparison between Preoperative Ultrasound Guided TAP Block and Caudal Block in Inguinal Hernia Repair in Paediatrics for Intraoperative and Postoperative Analgesia

Abstract Background Inguinal hernia repair is the most common scheduled sub-umbilical surgery done in day case paediatric surgical units. Using optimal analgesic regimens is essential to provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anaesthetic techniques are commonly used to facilitate pain control in paediatric surgical procedures. Aim of the Work To compare the effectiveness and safety of US guided TAP versus caudal block for postoperative analgesia in paediatric patients undergoing Unilateral Inguinal hernia repair. Patients and Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 20 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anaesthesia followed by the block at the beginning of the operation. Results the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in paediatric patients and also demonstrated that both analgesic techniques are safe. Conclusion From our study we can conclude that Ultrasound-guided transversus abdominis plane block and caudal epidural block are effective analgesics in children undergoing inguinal hernia repair surgery, with transversus plane block providing longer analgesic effect and decreased pain scores.

Comparison of the Analgesic Effect of Erector Spinae Plane Block Versus Caudal Epidural Block Following Unilateral Pediatric Inguinal Hernia Surgery: A Prospective, Randomized Study

Background: Caudal epidural block (CEB) has long been used as a standard method for pain control in pediatric surgery. Erector spinae plane block (ESPB) is a newer technique that has attracted attention for its potential to provide analgesia in children. Aim: The aim of this study was to compare and evaluate the effectiveness of ESPB and caudal block on postoperative pain in pediatric patients who underwent unilateral inguinal hernia surgery. Methods: This prospective, randomized trial was conducted with a total of 60 pediatric patients, aged 1–8 years, in the ASA I–II group. The patients were randomly divided into two groups as Group CEB (n = 30), and Group ESPB (n = 30). In the caudal block group, 0.25% bupivacaine 0.5 ml/kg (max 20 ml) was administered in the caudal space, while in the ESPB block group, the block was performed with 0.5 ml/kg 0.25% (max 20 ml) bupivacaine at the L1 vertebral level. Face, legs, activity, cry, and consolability (FLACC) scores were recorded postoperatively at 1, 2, 4, 6, 12, and 24th hours. The first analgesic requirements and time for rescue analgesia were also recorded. Results: While no significant difference was noticed between the two groups’ FLACC scores at the zeroth hour, first hour, second hour, fourth hour, and sixth hour (i.e. postoperatively [P &gt; 0.05]), the FLACC scores of 12th hour in the ESPB group were significantly lower than the caudal block group (P &lt; 0.05). There was also no significant difference in intraoperative additional analgesia requirements between the groups (P &gt; 0.05). The time to first postoperative analgesia in the ESPB group was higher than that in the caudal block group (P &lt; 0.05). Conclusion: The ESPB provided superior postoperative analgesia to the CEB in pediatric patients undergoing inguinal hernia surgery, and ESPB can be used as a relatively safer postoperative multimodal analgesia approach as an alternative to CEB.

Ultrasound-guided serratus anterior plane block versus paravertebral block for postoperative analgesia in children undergoing video-assisted thoracoscopic surgery: A randomized, comparative study

Ultrasound-guided serratus anterior plane block versus paravertebral block for postoperative analgesia in children undergoing video-assisted thoracoscopic surgery: A randomized, comparative study

A Comparative Study Of Caudal Epidural Bupivacaine And Midazolam-Bupivacaine Mixture For Post-Operative Analgesia In Children Repairing Congenital Inguinal Hernia

Background: Managing postoperative pain in pediatric anesthesia is challenging, with caudal epidural anesthesia being a preferred technique for its safety and efficacy. Enhancing analgesia duration through adjuvants like midazolam may improve outcomes. Objective: This study compares the effectiveness of caudal epidural bupivacaine alone versus a bupivacainemidazolam mixture in children undergoing repair of congenital inguinal hernia, circumcision, and hypospadias repair, focusing on postoperative analgesia duration and side effects. Materials and Methods: A double-blind randomized controlled trial was conducted at Islami Bank Medical College Hospital from October 2023 to March 2024, involving 50 children aged 2-8 years, divided into two groups: Group A (bupivacaine-midazolam) and Group B (bupivacaine alone). Pain was assessed using the FLACC scale at specified intervals up to 24 hours post-surgery. Results: Group A experienced significantly longer postoperative analgesia (10.72 ± 4.07 hours) compared to Group B (6.13 ± 1.98 hours). Mild pain was more common in Group A (72.7%) than Group B (87.5%), while moderate pain was higher in Group A (27.3%) than Group B (12.5%). Side effects were minimal, with Group A having no side effects and Group B experiencing 8% nausea and vomiting and 4% other side effects. Conclusion: The addition of midazolam to caudal bupivacaine significantly prolongs postoperative analgesia and reduces the need for rescue analgesia in children, with minimal side effects

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial.

Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) causes severe postoperative pain. Thoracic paravertebral block (PVB) provides excellent analgesia during various surgeries. We examined the effects of PVB on postoperative analgesia in children undergoing AIS surgery. In this study, 32 children scheduled for AIS surgery were randomly assigned to receive either PVB (PVB group) or no block (control group). The PVB group underwent surgeon-performed PVB with 0.5 mL/kg of adrenalized 0.2% ropivacaine on each side. The primary outcome was the pain score at rest at 6 h postoperatively. Secondary outcomes included pain scores both at rest and during movement and analgesic use for 48 h postoperatively. The postoperative resting pain scores at 6 h were comparable between the control and PVB groups (5.2 ± 2.0 and 5.1 ± 1.8, respectively), with no significant differences. However, at 1 h postoperatively, the control group showed significantly higher resting and mean moving pain scores than the PVB group (p < 0.05). The pain scores at other time points and analgesic use were comparable between the groups. Initial benefits of surgeon-performed bilateral PVB were observed but diminished at 6 h postoperatively. Future research using various anesthetics is needed to extend the effects of PVB.

Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial.

Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.

Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI).

Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.

Continuous Epidural Catheter for Postoperative Analgesia in Children: A Case Report

The management of postoperative pain in children and infants has now become a significant concern. Continuous epidural anesthesia is a proven method for controlling acute pain after surgery. We present the case of thoracic epidural analgesia used for the repair of an extensive burn involving the back and trunk, assisted by a skin graft, in a 6-year-old girl. Department of Pediatric Intensive Care Unit, Children's Hospital of Rabat. In pediatric surgery, postoperative pain awareness is crucial for medical and paramedical teams. Continuous epidural anesthesia, utilizing suitable equipment, is feasible for young children. Its advantages during long procedures are manifold: it eliminates the need for central analgesics, ensuring stable cardiovascular function and a calm awakening post-surgery. Moreover, it provides high-quality analgesia in the postoperative phase, decreasing morbidity and easing care for children. With safe analgesics and advances in locoregional anesthesia, managing postoperative pain in pediatrics has markedly improved.

Ultrasound guided quadratus lumborum block versus interlaminar epidural block for analgesia in pediatric abdominal surgery: a randomized controlled trial

BackgroundAlthough the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB.MethodsPatients were randomly allocated into two equal groups: Group E(n = 29): received EB; Group QL(n = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request.ResultsOur study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups(P > 0.05).ConclusionQLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries.Clinical trial registration numberPACTR202203906027106.

Acute Pain and Analgesia in children

Acute pain is a complex process involving activation of nociceptors, chemical mediators and inflammation. All the major children’s hospitals now have dedicated pain services to provide evaluation and immediate treatment of pain in any child. Children experience pain in a similar way to adults. Pain intensity in children depends on the surgical procedure itself but also on numerous other factors such as age, emotional state or the level of anxiety associated with the hospital stay. The perception and communication of the child’s pain depends on his or her intellectual and social development. Expression of pain therefore relies on the child’s ability to understand, quantitate and communicate it. Previous pain experiences or chronic diseases that required many medical procedures may significantly change the pain threshold in paediatric patients. Moreover, genetic predispositions and environmental effects are significant. The American Academy of Pediatrics and the American Pain Society have reiterated the importance of a multidisciplinary approach in order to eliminate pain in children. In all pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, especially in the emergency departments; therefore, an increasing number of age-related tools have been validated. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The total number of behaviors that are present in the child are used to estimate his/her pain at the time of assessment. Pain assessment is important to facilitate effective postoperative pain management in these vulnerable children. The purpose of this study is to investigate acute pain as well as analgesia and availability of the used analgesic drugs in children. A multimodal approach to preventing and treating pain is usually used.

Effectiveness of intravenous infusion of lidocaine for postoperative analgesia in children after various types of surgical interventions

Effectiveness of intravenous infusion of lidocaine for postoperative analgesia in children after various types of surgical interventions

Improving perioperative acetaminophen administration for safer and cost-effective multimodal analgesia in pediatric surgery: A QI initiative.

The use of acetaminophen in the perioperative period has emerged as an attractive option for providing safer and cost-effective analgesia in children. The primary aim of our project was to increase the use of acetaminophen (both oral and intravenous) in the perioperative period from a baseline of 39.5% to 50% for all surgical patients within 24 months. The secondary aim was to increase the use of enteral acetaminophen from 10% to 52.5% during the same period. A multidisciplinary team was formed, and model for improvement was chosen as the QI methodology. The primary measure was the total percentage of surgical patients receiving any form of perioperative acetaminophen, while our secondary measure was the percentage use of oral acetaminophen administration. We also tracked the average maximum PACU (Post Anesthesia Care Unit) pain scores and the percentage of patients receiving IV opioids. Multiple interventions were conducted, including education, increasing the availability of acetaminophen, and optimizing the electronic medical record (EMR). Monthly data was collected using an automated report in the EMR. We successfully achieved our goal, increasing the use of acetaminophen from 39.5% to 70% within four months. Despite some fluctuations, by the end of 24 months, we not only met but surpassed our goal, with 63% of patients receiving perioperative acetaminophen. Similarly, the usage of oral acetaminophen increased from a baseline of 10% to 78%. Our average maximum PACU pain scores improved from 5.4 to 5.2, and the percentage of patients receiving rescue opioids decreased from 15.4 to 13.1. We successfully achieved and sustained our goals of improving acetaminophen use for our surgical patients without worsening pain scores or worsening use of intravenous opioids. Future directions include further refining our strategies and exploring additional opportunities to optimize pain management in pediatric perioperative settings.

Comparison of post-operative analgesia with caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia

Post-operative pain relief following pediatric abdominal surgery is of paramount consideration and caudal block is still a popular, easy as well as safe analgesic technique for effective analgesia in children. With the advent of newer local anaesthetics, there has been a renewed interest in pediatric caudal blocks after lower abdominal surgeries following general anaesthesia. The aim of our study was to compare the efficacy and duration of postoperative analgesia using caudal Ropivacaine and Levobupivacaine in pediatric patients undergoing infraumbilical surgery under general anaesthesia.: The study was conducted on sixty, ASA grade 1, pediatric patients of age 2 to 6 years, of either sex, posted for elective infraumbilical surgery under general anaesthesia. They were randomly divided in two groups of 30 patients each. Group 1: - (n = 30) received caudal block with injection Ropivacaine, 0.25%, 1ml/kg. Group 2: - (n = 30) received caudal block with injection Levobupivacaine, 0.25%, 1ml/kg. Comparative, randomized, single blinded, observational study. : The demographic data was comparable in both the groups. Postoperatively, the quality of analgesia was assessed by the MOP (Modified Objective Pain Scale) score. Duration of postoperative analgesia was assessed by noting the time of giving rescue analgesia in the post-operative period. We also noted side effects, if any in both the groups. The quality of analgesia was found to be similar with both the drug groups (p value &amp;#62;0.05). The duration of analgesia was longer and statistically significant (p value = 0.0006) in the Ropivacaine group (8.43 ± 0.77 hours) as compared to the Levobupivacaine group (7.03 ± 2.03 hours). Statistically significant difference (P value = 0.026) was seen in the requirement rescue analgesia between Ropivacaine (3.33%) and Levobupivacaine (26.67%) groups. There were no major side effects in either of the groups, apart from a single patient out of 30 patients of Levobupivacaine group who had vomiting, compared with none in the Ropivacaine group.We conclude that caudal block with 0.25% Ropivacaine has a longer duration of action as compared to 0.25% Levobupivacaine in children undergoing infraumbilical surgery under general anaesthesia. Both Ropivacaine and Levobupivacaine, have similar quality of postoperative analgesia and side effect profile.

Genel Anestezi Altında Göbek Altı Ameliyatları Geçiren Çocuklarda Postoperatif Analjezi için Quadratus Lumborum Bloğu ile Transversus Abdominis Plan Bloğunun Karşılaştırılması: Prospektif Randomize Çalışma

Objective: Quadratus lumborum block (QL block) is a new addition to the truncal blocks used for postoperative analgesia of both upper and lower abdominal surgeries. We conducted this study to evaluate and compare the effect of the two truncal blocks QL-II block and transverses abdominis plane block on the of duration of effective analgesia in children undergoing infra umblical surgeries under general anesthesia. Methods: A prospective randomised study in patients between 1-7 years of age undergoing infraumbilical surgeries. 33 patients in each group. Group A received ipsilateral ultrasound guided Quadratus lumborum (QL) block group (0.5 ml kg-1 0.2% bupivacaine) and Group B received ipsilateral ultrasound guided Transversus abdominis plane block (TAP) (0.5 ml kg-1 0.2% bupivacaine). The primary outcome was the duration of effective in the postoperative period and secondary outcomes were the distribution of FLACC scores and Parent Satisfaction score. Results: The duration of effective analgesia was longer in group A (mean of 18.0 hours) when compared to group B (mean of 9.5 hours) in Quadratus lumborum (Type II) block group tends to have lesser pain scores (FLACC scale) and better parent satisfaction levels when compared with TAP block. Conclusion: Quadratus lumborum-II block provides longer duration of effective analgesia in the post–operative period in children aged 1-7 years undergoing infra umbilical surgeries under general anaesthesia. It also tends to achieve lesser pain scores and better parent satisfaction levels when compared with TAP block. Keywords: Bupivacaine, quadratus lumborum, satisfaction, analgesia, children

VARIOUS TYPES OF LOCOREGIONAL ANALGESIA IN PEDIATRIC PATIENTS

The regional blocks, as a part of multimodal analgesia, can improve pain managementin the postoperative period and reduce the rate of complications that arise when usinga single anesthesia regimen.The aim of the study – to compare the efficacy of various regional analgesia techniques.Materials and Methods. All patients were divided into two groups: Group I included31 children who underwent anterior abdominal wall surgery under general anesthesiawith the transversalis fascia plane block (TFPB); Group II comprised 32 children whounderwent anterior abdominal wall surgery under general anesthesia with the TFPB,combined with the quadratus lumborum block 4 (QLB-4) via a single injection.Results. In children of the I group, the pain intensity indicator on the visual analog scale(VAS) after one hour constituted 4.6±0.16 points, while in the children of the II group it was 3.5±0.15 (р&lt;0.05). The assessment of pain intensity according to VAS in thedynamics of the postoperative period showed that children of group I 6 hours aftersurgery have 1.2 times higher pain indicators compared to children of group II (p&lt;0.05),after 12 hours – by 1.7 times, after 24 hours – 1.6 times, after 36 hours – 1.5 times,and at discharge – 1.6 times (р&lt;0.001). According to the results of the LIKERT scale,significantly higher pain indicators were established in children of group I after surgeryand at the time of discharge (10.12±0.15 and 5.45±0.22 compared to 5.93±0.19 and3.50±0 .15 in children of group II (p&lt;0.001). The smallest volume of paracetamol usedfor pre-emptive and multimodal analgesia in children of group I was 95 ml, while inchildren of group II it was 40 ml. The largest volume, required by the children duringanalgesia was 220 mL and 150 mL in groups I and II, respectively.The mean time tocomplete the QLB-4 was 117.3±1.76 sec, while the TFPB was 121.8±3.56 sec (p =0.27).The duration of postoperative analgesia after performing the combined locoregionaltechnique was 32.56±0.5 hours, while when using the TFPB monoblock it was 22.9±0.57hours (p&lt;0.001).Conclusions. The use of a combined block for regional analgesia during operations onthe anterior abdominal wall is accompanied by: a lower indicator of pain intensity in thepostoperative period (p&lt;0.001); reducing the need to use «rescue doses of analgesics» inthe postoperative period (p&lt;0.001); the spread of the sensory block at the level of T7-L2dermatomes; an increase in the duration of postoperative analgesia (p&lt;0.001) comparedto the corresponding indicators when using the TFPB monoblock.

Effect of two different doses of nalbuphine for postoperative analgesia in children with cleft palate: a randomized controlled trial

BackgroundCleft palate repair surgery may result in severe pain in the immediate postoperative period. The aim of this study is to compare the effects of different doses of nalbuphine for postoperative analgesia in children with cleft palate.MethodsFrom November 2019 to June 2021, 90 children (45 males and 45 females, age 9–20 months old, ASA class I—II) were selected for palatoplasty. They were randomly divided into three groups: the control group (Group C), the N1 group (postoperative analgesia with 0.05 mg/kg/h nalbuphine) and the N2 group (postoperative analgesia with 0.075 mg/kg/h nalbuphine). Each group had 30 cases. Nalbuphine was not continuously infused in Group C but was continuously infused in Groups N1 and N2 at rates of 0.05 mg/kg/h and 0.075 mg/kg/h, respectively, for 24 h for postoperative analgesia. The FLACC analgesia score and Ramsay Sedation score were recorded at 10 min (T1), 30 min (T2), 2 h (T3), 12 h (T4) and 24 h (T5) after the operation. Adverse reactions such as nausea, vomiting and respiratory depression were observed and recorded.ResultsCompared with those in Group C, the FLACC scores in the N1 and N2 groups decreased significantly at T1-T5 (p < 0.05); the Ramsay Sedation score in the N1 group was significantly higher at T3 and T4 (p < 0.05), and that in the N2 group was significantly higher at T1-T5 (p < 0.05). Compared with that in the N1 group, the FLACC score in the N2 group was not significantly different, and the Ramsay Sedation score increased significantly at T5 (p < 0.05).ConclusionUsing 0.05 mg/kg/h Nalbuphine continuously for 24 h for postoperative analgesia in children with cleft palate has a better effect and fewer adverse reactions.Trial registrationThis study was registered at ChiCTR1900027385 (11/11/2019).