Analgesia In Children Research Articles

Pre-hospital analgesia in pediatric trauma and critically ill patients: An analysis of a German air rescue service

BackgroundPain management in the pre-hospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the pre-hospital use and effect of analgesics in children with trauma or pain due to other reasons.MethodsThis study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012–2020) to assess pain in general and whether patients with trauma pain due to other reasons received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0 = no pain). Effective pain reduction was analyzed.ResultsOut of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0–16 years. 20,405 cases were included in the study. 12,000 (58.8%) children had suffered a trauma, 8108 (39.7%) had pain due to other reasons and 297 (1.5%) had both. In total, 4,608 (38.4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still > 4. 282 patients within the non-trauma group had a pre-hospital NRS of > 4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the non-trauma group received no pain medication. In 16.0% the NRS at hospital admission was still > 4.ConclusionsGerman emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS > 4 after trauma. In case of non-trauma, the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide.Trial registration: The study has been retrospectively registered at DRKS (DRKS00026222).

Postoperative analgesia in children - a comprehensive assessment and management

Introduction. Pain is the most common cause of complaints in hospitalized pediatric patients. Pain continues to be underestimated and undertreated in childhood. The European Society of Pediatric Anesthetists has published guidelines for pain management in children. Pain assessment. Pain assessment is very important in the treatment of pain in children. Basic pain management. Administration of basic analgesics is crucial for pain management. Paracetamol and non-steroidal anti-inflammatory drugs. Generally, basic or simple analgesia includes the use of paracetamol and non-steroidal anti-inflammatory drugs. Systemic opioids. Opioids are reserved for early postoperative and intraoperative use when adequate monitoring and specially trained personnel are available around the clock. Regional anesthesia and local anesthetics. Regional anesthesia in children has been increasingly used in recent decades, particularly against the background of multimodal analgesia. Conclusion. Basic analgesics are crucial, and opioids are added only when needed. Regional anesthesia and local anesthetics play a superior role in pain management compared to systemic analgesics in such cases in pediatric patients.

Каудальная анестезия в педиатрической практике

Caudal anesthesia has been used for more than a hundred years. Caudal epidural blockade is the most commonly used regional technique in children and is considered the safest access to the epidural space. This method of anesthesia is used in combination with general anesthesia. With the correct implementation of this anesthetic manual, the risk of complications is small. The technique is used for peri- and postoperative analgesia in children of different ages. The main advantage of the method is high-quality anesthesia during caudal blockade, it is provided in 95–98 % of cases. The level of anesthesia depends on the amount of anesthetic administered; in some cases it may reach the level of the chest. The same advantage is the rapid onset of adequate analgesia and its long-term effect. For successful regional anesthesia in a pediatric patient, it is necessary for the anesthesiologist to know the anatomical and physiological structures of the body, the pharmacology of local anesthetics and the availability of the necessary medical equipment. The research presents a method of using caudal anesthesia as a component of anesthetic support for surgical interventions performed in children. We present the advantages and disadvantages of such anesthesia, indications and contraindications to its use, analyze possible complications, the implementation method.

Efficacy of perioperative analgesia in children with anorectal malformations

Efficacy of perioperative analgesia in children with anorectal malformations

Comparison of intranasal midazolam-fentanyl with dexmedetomidine–fentanyl as pre-medication in the paediatric age group

Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 μg/kg) and group B received intranasal dexmedetomidine (1 μg/kg)-fentanyl (2 μg/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher's Facial Pain Scale. Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher's Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine-fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Opioid sparing analgesia: Continuous intraoperative infusion of dexmedetomidine versus lidocaine for intracranial surgeries in children: A double-blind randomized clinical trial

ABSTRACT Background The usage of opioid sparing analgesia in different surgeries leads to varied results. The aim of this study is to compare between the effects of continuous intraoperative infusion of dexmedetomidine versus lidocaine as opioid sparing analgesia in children undergoing intracranial surgeries. Methods It is a double-blind randomized clinical study in which, 64 children were randomly allocated into 2 equal groups; 32 children for each group. The first one was dexmedetomidine group which received continuous intraoperative dexmedetomidine iv infusion [1ug/kg dexmedetomidine over 15 minutes as a loading dose and 0.5ug/kg/h for maintenance]. The second one was lidocaine group which received continuous intraoperative lidocaine iv infusion [1.5mg/kg lidocaine over 15 minutes as a loading dose and 1.5mg/kg/h for maintenance]. The continuous intraoperative iv infusion of each tested drug was stopped 10 minutes before the end the surgical procedure. Results Intraoperative total fentanyl consumption was significantly reduced in dexmdetomidine compared to lidocaine group ([19.33±11.15 vs 43.10±21.15] ug, 95% CI, -45.8 to -1.7). Children in dexmedetomidine group were significantly more sedated compared to lidocaine group. The time to reach Wong–Baker Faces Pain Rating Scale (WBFPS) scores 4 or more was around 4 hours in dexmedetomidine and around 1hour in lidocaine group. The time to first call of naluphine with dexmedetomidine was significantly prolonged compared to lidocaine ([235.03±5.02 vs 55.87±6.28] min, 95% CI, 176.3-182) with significantly reduced total postoperative naluphine consumption in dexmedetomidine compared to lidocaine ([4.22±1.46 vs 7.96±2.8] mg, 95% CI,-4.9 to -2.6) . The duration of PACU stay was significantly prolonged in lidocaine compared to dexmedetomidine ([99.75±14.36 vs 114.28±10.56] min, 95% CI,-20.8 to -8.2). Conclusion Continuous Intraoperative intravenous infusion of dexmedetomidine was superior to lidocaine in opioid sparing analgesia during intracranial surgeries in children.

To compare the efficacy of Gabapentin with Paracetamol for Preemptive Analgesia in children undergoing Tonsillectomy.

Aim: To compare the mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Method: This random controlled trial was conducted by Anesthesia team in ENT OT in Jinnah Hospital, Lahore from January 1, 2018 to June 30, 2018. After taking informed consent, 60 patients fulfilling the selection criteria were recruited and after obtaining demographic information, two groups were formed using lottery method Group G and Group P each having 30 patients. Patients were given oral Paracetamol 20 mg/kg and oral Gabapentin 10 mg/kg 120 minutes before induction of anesthesia in Group P and Group G respectively. Post-operatively, patients’ pain was monitored with VAS after every 30 minutes. When VAS exceeded 3, it marked the demand of first post-operative rescue analgesia was given and time was noted. Injection Ketorolac 0.5mg/kg was given as rescue analgesia. Mean time of first rescue analgesia was compared in between 2 groups via SPSS 19 Results: There were no significant differences for variables such as age and BMI in between two groups. The main result of study is that mean time for first rescue analgesia in group G and group P found to be 468.00± 57.14 & 377.00±51.47 minutes respectively. The calculated p-value was P < 0.0001 proving significant difference in duration for first analgesia in between two groups. Conclusion: There is significant difference in mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Keywords: Preemptive Analgesia, Gabapentine, Paracetamol, Post-operative pain control

Provision of immobilization or ice by paramedics in Southwestern Ontario.

Pain is the most common reason for prehospital transport. As emergency wait times increase, timely pain management is essential. In children, there is abundant evidence that prehospital pharmacologic analgesia is suboptimal, but little is known about non-pharmacologic therapies. We sought to characterize documentation by paramedics of non-pharmacologic (immobilization and ice) and pharmacologic analgesia in children with musculoskeletal injuries. We reviewed all ambulance call reports for children 0-17years transported to Southwestern Ontario regional hospitals from January 1, 2017, to December 31, 2019, with a musculoskeletal injury (Ontario Ministry of Health and Long-Term Care problem codes 66 and 67). Primary and secondary outcomes were documented immobilization or ice and pharmacologic analgesia, respectively. In a multivariable analysis, we explored the relationship between immobilization or ice and the following a priori covariates: age, sex, visible deformity, crew type, pain severity, and analgesia. Of 40,692 ambulance call reports reviewed, 4445 met inclusion criteria. There were 2584/4441 (58.2%) males, with a median (IQR) age of 14 (10, 16) years. In ambulance call reports with documented pain scores, 2106/3048 (69.1%) ambulance call reports reported "moderate or severe" pain. Immobilization or ice were documented in 1605/4445 (36.1%) and 385/4445 (8.7%) of ambulance call reports. Pharmacologic analgesia was documented in 275/1983 (13.9%) and 125/991 (12.6%) of ambulance call reports for primary care paramedics and advanced care paramedics, respectively. An increased odds of documented immobilization or ice was associated with moderate or severe pain [OR: 2.4; 95% CI 1.84-3.17; p < 0.01] and visible deformity [OR: 2.5; 95% CI 1.97-3.12; p < 0.01]. Documented immobilization and ice and pharmacologic analgesia to children by paramedics is suboptimal. Our findings underscore an important need for enhanced education surrounding the benefits of non-pharmacologic options for children with musculoskeletal injuries.

Acetaminophen pharmacokinetics in infants and children with congenital heart disease.

Acetaminophen is routinely used for perioperative analgesia in children undergoing major surgical procedures. There are few estimates of acetaminophen pharmacokinetic parameters in children with congenital heart disease, especially those with cyanotic heart disease. The current study prospectively investigated differences in acetaminophen pharmacokinetics following surgery using cardiopulmonary bypass in children with cyanotic and acyanotic congenital heart disease. Children (2-6 years, 9-23 kg) presenting for median sternotomy for Fontan palliation (cyanotic patients) or two ventricle surgical repair (acyanotic patients) were eligible for inclusion. A single intravenous dose of acetaminophen (15 mg/kg) was administered at the start of sternal closure after separation from cardiopulmonary bypass. The time-course of acetaminophen concentrations were described using non-linear mixed effects models. One and two-compartment disposition models with first-order elimination were tested. Pharmacokinetic parameter estimates were scaled using allometry and standardized to a 70 kg person. There were 208 acetaminophen concentrations assayed from 30 children, 15 with cyanotic, and 15 with acyanotic heart disease. A 2-compartment model best described acetaminophen PK. Parameter estimates (population parameter variability, PPV%; 95% confidence interval, CI) were clearance CL 15.3L.h-1.70 kg-1 (22.2%; 13.8-16.7), intercompartment clearance Q 45.4L.h-1.70 kg-1 (22.4%; 25.2-61.9), central volume of distribution V1 33.5L.70 kg-1 (23.2%; 25.9-38.8), peripheral volume of distribution V2 32.1L.70 kg-1 (21.7%; 25.9-38.8). Neither clearance nor volume parameters differed between cyanotic and acyanotic patients. Acetaminophen pharmacokinetics were characterized using a 2-compartment model with first-order elimination following cardiac bypass surgery in children. Population pharmacokinetic parameter estimates were similar to other studies in children. No differences were detected between patients with cyanotic and acyanotic heart disease.

Evaluation and Treatment of Pain in Fetuses, Neonates and Children.

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.

Dexmedetomidine-Ketamine or Dexmedetomidine-Midazolam Nebulised Drug Combination as a Premedicant in Children: A Randomised Clinical Trial.

This study was designed to evaluate the clinical efficacy of 2 low-dose nebulised drug combinations of dexmedetomidine-ketamine and dexmedetomidine-midazolam as a premedication in children scheduled for surgery under general anaesthesia. Sixty children classified as American Society of Anesthesiologists physical status I, aged between 3 and 10, listed to undergo elective surgeries under general anaesthesia were enrolled in this prospective, randomised, and double-blind trial. Patients were randomly allocated to receive nebulised premedication approximately 30 minutes before the induction of anaesthesia. Group DK (n=30) received combined nebulised dexmedetomidine and ketamine (1 μg kg-1+1 mg kg-1 ) and the dexmedetomidine-midazolam (DM) group (n=30) received combined nebulised dexmedetomidine and midazolam (1 μg kg-1+0.1 mg kg-1 ). All children were anaesthetised with a protocolised anaesthesia technique. The primary end point was the level of sedation when the child was first seen in the operating room 30 minutes after nebulisation. The secondary end points were parental separation and ease of induction, ease of acceptance of IV cannula, mask acceptance, postoperative analgesia, and wake-up behaviour. Studied groups were comparable in demographic data (age, weight, and sex) and duration of anaesthesia. Level of sedation at 30 minutes was significantly greater in the DM group than in the DK group (P =.013) while the two were comparable in parental separation and ease of induction (P =.808). Group DK exhibited superior ease of acceptance of IV cannula (P =.001), mask acceptance score (P =.001), and postoperative analgesia (P =.021). Hemodynamic parameters and oxygen saturation remained comparable at all time intervals as also the wake-up behaviour. The nebulised combination of low-dose ketamine and dexmedetomidine was a superior combination producing acceptable sedation with enhanced ease of IV acceptance, mask acceptance, and postoperative analgesia in children.

Ultrasound-guided lumbar plexus block versus transversus abdominis plane block for analgesia in children with hip dislocation: A double-blind, randomized trial.

Lumbar plexus block is often used as analgesia for adult hip surgery, but it is rarely used in pediatric patients. This study aimed to compare the efficacy and feasibility of ultrasound-guided lumbar plexus block versus transversus abdominis plane block for postoperative analgesia in children with hip dislocation. Eighty children undergoing unilateral hip dislocation surgeries at our hospital from October 2019 to February 2021 were randomized to the lumbar plexus block group (group L) and transversus abdominis plane block group (group T). Compared with group L, the regional block time in group T was lower (8.0 ± 2.5 vs 11.5 ± 2.3 min, P < 0.05), and the ultrasound image definition was better (P < 0.05). There were no significant differences in mean blood pressure and heart rate within 24 h (all P > 0.05). Children's Hospital of Eastern Ontario Pain Scale scores were lower in group L than in group T at 18-24 h only (all P < 0.05). The satisfying analgesia rate in group L was higher than in group T (87.5 vs 65%, P < 0.05). No regional block-related complications were found in both groups. Ultrasound-guided lumbar plexus block showed a longer postoperative analgesic effect in children with hip dislocation compared with transversus abdominis plane block.

Use of Epidural Analgesia in Children With Neuromuscular Conditions Following Hip Reconstruction.

Background: Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations. However, postoperative pain management remains an elusive and challenging problem. The purpose of this study was to determine whether postoperative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control, and complications as compared to traditional pain management regimens. To our knowledge, this is the first study comparing the use of epidural analgesia to conventional pain relief modalities following hip reconstruction in patients with neuromuscular conditions.Methods: A retrospective cohort study was performed using records of pediatric patients with neuromuscular conditions treated at our tertiary care center between January 2009 and December 2019. Patients with neuromuscular conditions treated with epidural or non-epidural analgesia for pain relief following unilateral or bilateral proximal femoral osteotomies, pelvic osteotomies, or open hip reduction were eligible for study inclusion. Multiple linear regression was used to determine differences in length of stay, pain score, pain modality, duration of Foley placement, and complications between the two cohorts.Results: Seventy patients met the inclusion criteria for the study. In all, 58 patients underwent unilateral procedures, of which 30 (52%) received epidural analgesia, and 28 (48%) received non-epidural pain control modalities. Demographic and baseline characteristics were similar among the cohort, except for BMI, which varied slightly. Average pain scores and pain control duration were not statistically different between the pain control modalities. After controlling for demographics, procedure, and immobilization type, the epidural group experienced significantly increased length of stay (+3.18 days, P=0.032) and duration of Foley placement (+1.04 days, P=.013). Complication rates between the two groups were not statistically significant.Conclusions: The use of epidural analgesia in children with neuromuscular conditions was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement. No statistically significant difference in complication rates was observed between patients receiving epidural anesthesia and those receiving traditional pain modalities.

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery.&#x0D; Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia.&#x0D; Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery.&#x0D; Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block.&#x0D; Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017&#x0D;

Comparison of intravenous ibuprofen versus ketorolac for postoperative analgesia in children undergoing lower abdominal surgery: A randomized, controlled, non-inferiority study.

Non-steroidal anti-inflammatory drugs are often used as part of multimodal analgesia to control postoperative pain. This randomized, controlled, double-blinded, non-inferiority study aimed to compare the postoperative analgesic effects of intravenous ibuprofen versus ketorolac in children undergoing open unilateral lower abdominal surgery. The authors hypothesized that postoperative analgesia produced by intravenous ibuprofen would be non-inferior to that of intravenous ketorolac. Sixty-six children aged 2 to 8 years who were scheduled to undergo unilateral lower abdominal surgery, were recruited. Patients in the ibuprofen group received 10mg/kg/6h intravenous ibuprofen. Patients in the ketorolac group were given 0.5mg/kg/6h intravenous ketorolac. The primary outcome measure was 24-h postoperative morphine consumption. The secondary outcome measures were postoperative pain score, the incidence of early postoperative fever and the incidence of ibuprofen and ketorolac adverse effects including pain during drug infusion, vomiting, epigastric pain and allergic reaction. Fifty-nine patients completed the study (30 ibuprofen, 29 ketorolac). There was no significant difference (P=0.305) in the mean (SD) 24-h postoperative morphine consumption (μ/kg) between intravenous ibuprofen, 16.00 (5.31), and ketorolac, 14.65 (4.61). The reported pain scores were similar in both groups. The incidence of postoperative fever was significantly lower (p=0.039) in the ibuprofen group (3%) than the ketorolac group (20%). The incidence of adverse effects was similar in both ibuprofen and ketorolac groups. Intravenous ibuprofen can be used as an alternative to ketorolac for postoperative analgesia in children undergoing unilateral lower abdominal surgery because both drugs similarly provide safe and effective postoperative analgesia.

Preliminary Experience With Quadratus Lumborum Catheters for Postoperative Pain Management in Pediatric-Aged Patients With Contraindications to Epidural Anesthesia.

Although neuraxial techniques such as caudal and epidural anesthesia were initially the predominant regional anesthetic technique used to provide postoperative analgesia in children, there has been a transition to the use of peripheral nerve blockade such as the quadratus lumborum block (QLB). We present preliminary experience with QL catheters for continuous postoperative analgesia in a cohort of pediatric patients following colorectal surgery. After institutional review board (IRB) approval, we retrospectively reviewed the records of patients who underwent major colorectal surgery and received QL catheters for postoperative analgesia. The postoperative pain control data consisted of QL catheter characteristics, anesthetic agents, adjuncts, pain scores, and opioid consumption during the postoperative period. The study cohort included eight pediatric patients, ranging in age from 1 to 19 years (median age 11.8 years). The QL catheters were placed in the operating room after the induction of anesthesia. Comorbid conditions in the cohort that were contraindications to neuraxial anesthesia included spinal/vertebral malformations, presence of a ventriculoperitoneal (VP) shunt, anal atresia, tracheo-esophageal fistula (VACTERL) association, and coagulation disturbances. All patients underwent complex colorectal or genito-urologic procedures. Bilateral QL catheters were placed in six patients, and unilateral catheters were placed in two patients. Four patients received 0.5% ropivacaine and four patients received 0.2% ropivacaine of an initial bolus. The local anesthetic used for continuous infusion was 0.2% ropivacaine in five patients, 0.1% ropivacaine in two patients, and 1.5% chloroprocaine in one patient, with a median infusion rate of 0.11 mL/kg/h. QL catheter infusions were supplemented with intravenous opioids delivered by patient-controlled or nurse-controlled analgesia. The median opioid requirements in oral morphine milligram equivalents (MME) were 1.2, 1.0, 1.1, 0.5, and 0.6 MME/kg on postoperative days 1 - 5. Daily median pain scores were ≤ 2 during the 5-day postoperative course. All catheters functioned successfully and were in place for a median of 79.3 h. Other than early inadvertent removal of two catheters, no adverse effects were noted. Although our preliminary data suggest the efficacy of QL catheters in providing prolonged postoperative analgesia for up to 3 - 5 days following colorectal procedures, attention needs to be directed at measures to ensure that the catheter is secured to avoid inadvertent removal.

Dexmedetomidine and perioperative analgesia in children.

Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.

Evaluating the role for regional analgesia in children with spina bifida: a retrospective observational study comparing the efficacy of regional versus systemic analgesia protocols following major urological surgery

IntroductionRegional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina...

Perioperative Pain Management in Children

Acute pain therapy in children is highly complex. Already preoperatively, the course for a successful therapy is set in the interaction with the child and parents. The goal of the treatment is a satisfied child. This means the use of empathy and therapy planning aimed at a balance between effect and side effect and functionality. Modern concepts are opioid-sparing and procedure-specific. Regional anaesthesia plays a major role, among other things due to excellent safety data. Knowledge of age- and block-specific local anaesthetic dosages is essential. Little is known about pharmacodynamic data of analgesics in children. Although knowledge about pharmacokinetic characteristics is increasing, off-label use of analgesics is inevitable. International databases such as the Kinderformularium provide up-to-date information. When using opioids, rules for safe handling must be followed both in terms of use and prescribing. Non-opioids and adjuvants - individually or in combination - have an established place in perioperative pain management. Non-pharmacological interventions can reduce anxiety and pain. Anxiety is one of the risk factors for chronic postsurgical pain.

A Comparative Study to Evaluate the Efficacy of Dexmedetomidine and Clonidine to Accentuate the Perioperative Analgesia of Caudal 0.25% Isobaric Levobupivacaine in Pediatric Infraumbilical Surgeries

BackgroundCaudal block is an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. It enables early ambulation and periprocedural hemodynamic stability. These are important advantages over general anesthesia, notably in preterm babies and in children with cardiopulmonary comorbidities. In this study, we aimed to compare the effect of dexmedetomidine and clonidine to accentuate the perioperative analgesia of 0.25% isobaric levobupivacaine in pediatric caudal anesthesia.MethodologyA prospective double-blind randomized control study was conducted on 60 patients with the American Society of Anesthesiologists (ASA) physical status I, between the ages of one to six undergoing infraumbilical abdominal surgery under caudal anesthesia in the Department of Anaesthesia, Sardar Patel Medical College, Bikaner. Patients were randomly allocated to the following three groups of 20 each: group L, 1 mL/kg of levobupivacaine 0.25%; group LD, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of dexmedetomidine; and group LC, 1 mL/kg of levobupivacaine 0.25% with 0.5 µg/kg of clonidine. Intraoperative and postoperative hemodynamic parameters were recorded for 24 hours. Patients’ pain scores, sedation scores, and Bromage scores were recorded. In our study, the main observation was the duration of analgesia and the total analgesic requirement for 24 hours.ResultsThere was a significant difference in the duration of analgesia among the three groups (p < 0.001). Group LC had the highest duration of analgesia of 492.00 (50.01) minutes, followed by group LD 486.00 (54.71) minutes, and the lowest in group L 291.00 (40.25) minutes. There was a significant difference between the three groups in terms of the total dose of analgesics in 24 hours (p < 0.001), with the median total dose of analgesics being the highest in Group L. Three groups differed significantly in terms of motor block, which was limited to up to 180 minutes in groups LC and LD with no residual motor block.ConclusionsThe addition of α2 agonists such as clonidine or dexmedetomidine at a dose of 0.5 µg/kg as an adjuvant to caudal levobupivacaine (0.25%) at 1 mL/kg significantly prolongs the duration of opioid-free analgesia in children undergoing infraumbilical abdominal surgeries without prolonging the motor blockade and any side effects. Moreover, dexmedetomidine does not offer a significant advantage over clonidine regarding the analgesia duration.