Postoperative Pain In Pediatric Patients Research Articles

Efficacy of Quadratus Lumborum Block Compared to Paravertebral Block on Pediatric Patients Undergoing Abdominal Surgery

Background: Abdominal surgery is a major procedure associated with severe postoperative pain in pediatric patients. Quadratus lumborum block (QLB) is considered an effective pain control in such cases. Paraverterbral block (PVB) is another option for postoperative pain management. The aim of this study was to compare the effectiveness of quadratus lumborum block with paravertebral block. Methods: This single-blind randomized controlled trial included 22 pediatric patients who underwent abdominal surgery at Sanglah Hospital, Denpasar between August – October 2022. Research subjects were divided into 2 treatment groups; group A consisted of general anesthesia combined with quadratus lumborum block and group B consisted of general anesthesia combined with paravertebral block. Duration of analgesia was recorded based on the time to analgesic rescue, FLACC pain scale at 0, 2, 4, 6, 12 and 24 hours and total opioid consumption 24 hours after surgery. Statistical analyses were performed using SPSS. Results: Eleven patients received QLB and PVB respectively. There was a significant difference in mean analgesia duration of 1287 ± 129.69 minutes compared to 750 ± 122.22 minutes (p < 0.001) (CI 95%: 425.18 – 649.36), median FLACC pain scale at 12 (1 (IQR 2) vs 4 (IQR 1)) and 24 hours postoperative (1 (IQR 2) vs 3 (IQR 1)) between QLB and PVB (p < 0.001 and p < 0.007). Mean 24-hour postoperative opioid consumption was significantly lower in the QLB compared to the PVB. Conclusion: QLB has better effectiveness than PVB in pediatrics undergoing abdominal surgery.

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 > 0.05]), the FLACC scores of 12th hour in the ESPB group were significantly lower than the caudal block group (P < 0.05). There was also no significant difference in intraoperative additional analgesia requirements between the groups (P > 0.05). The time to first postoperative analgesia in the ESPB group was higher than that in the caudal block group (P < 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.

Comparative Analysis of Bupivacaine Versus Bupivacaine with Dexmedetomidine in Caudal Block Anesthesia

Background: Postoperative pain in pediatric patients remains a critical concern, with traditional caudal blocks using bupivacaine often providing limited analgesia duration. Adding dexmedetomidine to bupivacaine may enhance analgesic effects and improve hemodynamic stability.Objective: To compare the effectiveness of bupivacaine alone versus bupivacaine combined with dexmedetomidine in caudal anesthesia for pediatric patients undergoing perurethral cystolithotripsy.Methods: A prospective cohort study was conducted on 50 pediatric patients, aged 2 months to 7 years, divided into two equal groups. Group A received caudal bupivacaine 0.25% (1 ml/kg), and Group B received caudal bupivacaine 0.25% with dexmedetomidine (1 µg/kg). Heart rate, mean arterial pressure (MAP), respiratory rate, FLACC score, and Ramsay sedation score were recorded intraoperatively and at multiple postoperative intervals. Data were analyzed using SPSS version 25, with an independent t-test and chi-square test.Results: Group B showed significantly lower mean FLACC scores (0.80 vs. 3.08 at 60 min, p=0.024) and higher sedation scores (3.60 vs. 1.60 at 60 min, p=0.000) compared to Group A. Heart rate and MAP were more stable in Group B (p<0.05).Conclusion: Dexmedetomidine combined with bupivacaine provided superior analgesia and sedation with improved hemodynamic stability compared to bupivacaine alone.

The Role of Regional Anesthesia in Reducing Postoperative Pain in Pediatric Patients

Introduction: Ensuring adequate analgesia is crucial for minimizing morbidity and healthcare costs, ultimately enhancing the success of ambulatory surgery outcomes. The purpose of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Aim of the study: The aim of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Methods: This prospective observational study included 60 pediatric patients who underwent various surgical procedures with regional anesthesia at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, Bangladesh, from January 1, 2022, to December 31, 2023. Patients aged < 15 years were included, with baseline pain scores recorded preoperatively and postoperative pain levels assessed at 1, 3, 6, 12, and 24 hours. Data on regional anesthesia techniques and pain scores were analyzed using SPSS version 22.0. Result: The study revealed that the largest group of pediatric patients were aged 7–14 years, with regional anesthesia techniques like upper and lower limb blocks being the most common. Postoperatively, 33.33% of Neonates and Infants reported a pain score of 0 within the first 3 hours, while nausea and postdural puncture headache (PDPH) were observed in 25.00% and 13.33% of patients, respectively. Most patients had a hospital stay of 4–6 days, though 21.67% required more than 10 days. Conclusion: Regional anesthesia effectively reduced postoperative pain in pediatric patients, demonstrating significant pain management benefits, minimal complications, and a positive impact on recovery and hospital stay duration.

The effect of intraoperative methadone on postoperative opioid requirements in children undergoing orchiopexy: A randomized clinical trial.

Children undergoing outpatient surgery are at risk of inadequate postoperative pain control. Methadone has a long duration of action and an intraoperative dose may provide stable analgesia throughout the postoperative period. Intraoperative methadone has been shown to improve pain control in adolescents but its use for postoperative pain in pediatric patients undergoing outpatient surgery has not been studied before. Therefore, we conducted a double-blind randomized placebo-controlled trial to investigate the effects of a single dose of intraoperative methadone in children aged less than 5 years undergoing orchiopexy for undescended testis. A total of 68 children were randomized to receive either methadone (0.1 mg/kg) or isotonic saline following induction of anesthesia. Exclusion criteria included preterm birth, previous scrotal surgery, and parents' inability to consent. Primary outcomes were opioid requirements (first primary outcome) and pain intensity in the post-anesthesia care unit. Secondary outcomes included episodes of desaturation and time until readiness to discharge from the post-anesthesia care unit, sleep on the first postoperative night, pain intensity, and opioid requirements at home until the evening on the first postoperative day. Follow-up was 4 days. Sixty children completed the study (age, mean ± SD, 26.2 ± 13.9 months), 29 children received methadone, and 31 children received placebo. Eighteen children required opioids in the post-anesthesia care unit, five children in the methadone group (proportion = 0.17, 95% confidence interval (CI): 0.07, 0.36) compared to thirteen patients in the placebo group (0.42, 95% CI: 0.26, 0.60) (mean difference = -0.24 and 95% CI: -0.03, -0.47) (p = 0.037). Five children in the methadone group (0.17, 95% CI: 0.03, 0.31) versus ten in the placebo group (0.32, 95% CI: 0.16, 0.49) had a face, legs, activity, cry, consolability score of ≥5 in the post-anesthesia care unit (mean difference = -0.15, 95% CI: -0.36, 0.06) (p = .179). More children in the placebo group woke up due to pain the first night following surgery (seven children vs. one child). The methadone group had a longer stay in the post-anesthesia care unit. There were no differences between the two groups regarding the other secondary outcomes. A single dose of intraoperative methadone reduces short-term postoperative opioid requirements in children after orchiopexy for nondescended testes but prolongs the duration of their stay in the post-anesthesia care unit.

Effects of prophylactic nalbuphine on emergence agitation and postoperative pain in pediatric patients undergoing ENT surgery with sevoflurane anesthesia.

Emergence agitation (EA) is a common complication in the pediatric population. This study aimed to investigate the effect of the prophylactic nalbuphine on EA in pediatric patients receiving sevoflurane anesthesia. The children undergoing ear, nose, and throat (ENT) surgery were administered 0.2 mg/kg nalbuphine (the nalbuphine group) or the same volume of normal saline (the control group) 5 min before the end of the surgery. The extubating time, time to eye-opening and duration of the post-anesthesia care unit (PACU) were recorded. Heart rate and blood pressure were monitored before and 5 min after nalbuphine administration. Pain was assessed using Face Legs Activity Cry and Consolability (FLACC) scales, and the drug-related postoperative complications (e.g., EA, delayed awakening, nausea and vomiting, and respiratory depression) were recorded. One-hundred and thirty pediatric patients were randomly divided into nalbuphine and control groups (n = 65). The nalbuphine group showed a significantly lower incidence of EA than the control group (20% vs. 46.2%, P = 0.002). No significant differences between the two groups were observed in heart rate and blood pressure 5 min after nalbuphine administration (P > 0.05). No significant differences were observed between the two groups regarding extubating time, time to eye-opening, and duration of PACU. The FLACC scales demonstrated lower values in the nalbuphine group than in the control group during the initial 4 h after the surgery. However, the FLACC scales showed similar values between 5 and 12 h after the surgery. In summary, the results of this study demonstrated that prophylactic natbuphine could minimize the incidence of EA in pediatric patients following ENT surgery without increasing the extubating time and PACU duration. http://www.chictr.org.cn, identifier [ChiCTR2300070046].

Incidence and Predictors of Postoperative Pain in Pediatric Patients Underwent Ophthalmological Surgery at Hawassa University Comprehensive Specialized Hospital : A Prospective Cohort Study

Incidence and Predictors of Postoperative Pain in Pediatric Patients Underwent Ophthalmological Surgery at Hawassa University Comprehensive Specialized Hospital : A Prospective Cohort Study

Postoperative Pain Comparison: Manual K-Files vs Pedoflex Rotary Files in Primary Molar Root Canals

This study evaluated postoperative pain in pediatric patients after root canal treatment with two file systems: Manual K-files and Pedoflex Rotary files. Sixty children, aged 6-10, were randomized into two groups of 30. Pain was assessed using a Visual Analog Scale (VAS) at 6, 12, 24, and 48 hours post-treatment. Results showed significantly lower pain levels in the Pedoflex Rotary file group at all time points (mean VAS at 6 hours: 2.4 vs. 3.8; at 12 hours: 1.8 vs. 3.2; at 24 hours: 1.2 vs. 2.5; at 48 hours: 0.6 vs. 1.8). Pedoflex Rotary files provide a more comfortable postoperative experience.

Intraoperative application of low-dose dexmedetomidine or lidocaine for postoperative analgesia in pediatric patients following craniotomy: a randomized double-blind placebo-controlled trial.

Postoperative pain is a common occurrence in pediatric patients following craniotomy, often leading to negative outcomes. Intravenous dexmedetomidine and lidocaine are commonly used adjuvant medicines in general anesthesia to reduce perioperative opioid consumption and relieve postoperative pain in adults. While they show promise for use in pediatrics, the evidence of their application in pediatric craniotomy patients is limited. Therefore, we aimed to compare the effects of dexmedetomidine and lidocaine on postoperative pain in pediatric patients following craniotomy. We conducted a randomized, double-blind, single-center trial on children scheduled for craniotomy. The 255 recruited participants aged 1-12 years were randomly assigned to intraoperatively receive a loading intravenous dose of either dexmedetomidine 1 μg·kg-1 or lidocaine 2 mg·kg-1 or normal saline for 15 min followed by dexmedetomidine 0.5 μg·kg-1·h-1 or lidocaine 1 mg·kg-1·h-1 or normal saline until the sutures of endocranium were completed. The primary outcome was the cumulative sufentanil consumption within 24 h post-surgery. A total of 241 patients were included in the statistical analysis. The primary outcome did not show any significant differences among the three groups (median (IQR) lidocaine group: 3.36 (1.32-5.64) μg vs. dexmedetomidine group: 3.12 (1.36-6.39) μg vs. control group 3.46 (1.77-7.62) μg, p = 0.485). Among the secondary outcomes, there was a statistically significant but small reduction in sufentanil consumption within 2 h, postoperative FLACC/WBFS/NRS pain scores within 4 h after surgery and postoperative Ramsay sedation scores in dexmedetomidine group (p < 0.05). Regarding postoperative complications, the incidence of electrolyte disturbance within 24 and 48 h after surgery was significantly higher in control group compared to the other two groups. There were no significant differences in intraoperative opioid consumption, postoperative frequency of remedy medication, or length of hospitalization among the three groups. No adverse events related to lidocaine or dexmedetomidine were observed. There were no significant differences in the primary outcome among the three groups. Although dexmedetomidine showed some benefits in reducing postoperative opioid consumption within the first 2 h and pain intensity within the first 4 h post-surgery, these findings should be interpreted with caution. Further research is required to comprehensively assess the outcomes and determine the optimal administration strategy. [http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1800019411].

Comparison of bolus dose administration of propofol and dexmedetomidine for incidence of emergence delirium in pediatric patients undergoing surgery with general anesthesia: A randomized, double-blind trial

Abstract Background and Aims: Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Material and Methods: Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. Results: The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. Conclusion: In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.

Exploring Novel Non-pharmacologic Approaches to Address Preoperative Anxiety and Postoperative Pain in Pediatric Patients Undergoing In-Patient Surgical Procedures: A Scoping Review.

The pediatric population is more prone to experiencing anxiety and fear before undergoing an inpatient surgical procedure than adults. Non-pharmaceutical interventions, such as music therapy and virtual reality programs, have shown significant promise in reducing the post-operative pain associated with pre-operative anxiety of patients and their caregivers. While there is evidence to support the use of non-pharmaceutical treatment in the mitigation of pre-operative anxiety, there are limited published reports of non-pharmacological interventions for pre-operative anxiety in children undergoing inpatient surgical procedures. The goal of this scoping review was to identify and classify specific non-pharmacological interventions utilized inpatient among children to improve pre-operative anxiety and post-operative complications inflicting pain. Comprehensive searches were conducted using Ovid Medline, Embase Emtree, CINAHL Complete, and COCHRANE Central databases. The articles had to be peer-reviewed, written in English, published between 2000-2022, and contain measurements of pre-operative anxiety and post-operative pain to be included in the scoping review. Articles that reported findings on patients younger than 18 undergoing elective and/or routine surgeries, excluding emergent surgical cases, were selected. After a systemized screening process, 9 articles were selected for the final review. The findings indicated that non-pharmacological interventions such as virtual reality, hypnosis, and clowns reduced pre-operative anxiety and post-operative pain in pediatric patients. This scoping review identified a wide range of non-pharmacological interventions to mitigate the post-operative effects of pre-operative anxiety among children, including but not limited to music, visual reality, and other holistic methods. More longitudinal studies are warranted to understand the specific interventions that may be the most efficacious.

Different Analgesia Techniques for Postoperative Pain in Children Undergoing Abdominal Surgery for Intractable Constipation: A Retrospective Cohort Study in a Single Tertiary Children's Hospital.

Functional constipation in the pediatric population is a prevalent issue that is usually well managed. However, in rare cases, conservative treatment fails, and surgical intervention is necessary. This retrospective cohort study aimed to describe and compare different perioperative analgesic techniques in children undergoing major abdominal surgery for intractable constipation. Conducted between 2011 and 2021, this study enrolled patients under 18 years old who underwent initial major abdominal surgery for intractable constipation (i.e., creation of ostomy or subtotal colectomy). Patients were categorized according to the perioperative analgesic technique (i.e., systemic, neuraxial, or truncal block). Of 65 patients, 46 (70.8%) were female, and the median age was 13.5 [8.8-16.1] years during initial major abdominal surgery. Systemic analgesia was used in 43 (66.2%), neuraxial in 17 (26.2%), and truncal blocks in 5 (7.7%) of the surgeries. Patients with neuraxial analgesia reported less postoperative pain (median [interquartile range] numeric rating scale (NRS) 2.0 [0-4.0]), compared to systemic analgesia (5.0 [2.0-7.0], p < 0.001) and to truncal blocks (5.0 [3.0-6.5], p < 0.001). In this preliminary investigation, neuraxial analgesia appears to be the most effective approach to reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. However, well-designed studies are warranted.

Retrospective Analyses of Sacral Erector Spinae Plane Blocks in Pediatric Patients

Objective: The erector spinae plane block (ESPB) was first described in 2016. Recently the use of ESPB at the sacral levels was defined for adult surgeries, and a modification of the technique for pediatric surgeries, with the claim that it could replace caudal blocks, was described by our clinic. Methods: This retrospective cohort study was approved by the institutional ethical committee of Kocaeli University Hospital (GOKAEK-2021/6.04). The data were obtained from the registry of regional anesthesia saved in the department. Pre- and perioperative data regarding age, height, weight, American Society of Anesthesiologist classification, surgery duration, and anesthesia duration during the perioperative period were collected. US-guided S-ESPB was successfully applied to 16 patients included in the retrospective study. The registry of regional anesthesia data includes detailed information on block performance, postoperative pain severity, and complications in the early postoperative period (for at least 24 h). Results: 16 pediatric patients were included in the retrospective study. The mean age of the patients was 21,5 months. The mean weight of the patients was 13,1kg. In the postoperative 24-hour follow-up, one patient had a The Face, Legs, Activity, Cry, Consolability (FLACC) score greater than 4 in the PACU. None of the patients were observed to have postoperative complications. Conclusions: To our knowledge, this study is the first to retrospectively investigate the efficacy of the S-ESPB in pain management in pediatric patients. The sacral ESPB appears to be an effective option for postoperative pain in pediatric patients undergoing lower abdominal surgery.

Analgesia Nociception Index Monitoring in the Evaluation of Postoperative Pain in Children: A Prospective Observational Pilot Study

PurposeIn this study, we aimed to evaluate the relationship between the analgesia nociception index (ANI) device and pain scales used in the postoperative pain assessment of pediatric patients who underwent laparoscopic appendectomy. DesignThe study was designed as a correlation observational pilot study. MethodsPostoperative pain was evaluated using pediatric pain scales (face, legs, arms, cry, consolability scale; numerical rating scale; Wong–Baker scale) and ANI device in school-aged children and adolescents. ResultsThe mean age of the children was 14.00 ± 1.63 years, and the mean BMI was 22.52. We found a statistically significant positive correlation between the pain scale scores and a statistically significant negative relationship between the pain scale score and the ANI. ConclusionsThe ANI device can be used safely and constantly for the objective assessment of postoperative pain in pediatric patients.

Postoperative pain relief in pediatric surgery patients: Effect of intravenous paracetamol in comparison with diclofenac suppository

Background: Pain is a major problem regarding quality of life in children undergoing surgicaloperation.Pain assessment is the most important and critical component of pain management. Oral andrectal paracetamol formulations are associated with a slower onset of action and more variableanalgesic activity than IV acetaminophen, making them less useful in preoperative and acute caresettings. Objective: To find out the effect of intravenous paracetamol in releiving postoperative pain in pediatricpatients. Settings and study design: This randomized clinical trial study was conducted in theAnaesthesiology department of Sir Salimullah Medical College Mitford Hospital,Dhaka fromFebruary' 2014 to August' 2014. A total of 100 cases were taken, they were randomly divided into twogroups in which one group received intravenous paracetamol and another group received diclofenacsuppository for the same operation performed on them, age of the children were between 4-12 years, andall were ASA grade I. Pain relief was assessed with VAS score from 30 minutes after surgery up to 6hours with regular follow up and comparison made between the two groups. Results: In this study, comparisons by mean visual analog scale between intravenous paracetamolwith diclofenac suppository groups were done. VAS score showed both analgesic reduces pain, butdiclofenac suppository was found better post operative pain reliever than intravenous paracetamolwithin observed 30 min to 2 hours. However observed after 6 hours, diclofenac suppository group issignificantly better than intravenous paracetamol group in relieving post operative pain by measuringVAS. Conclusion: Our study showed that diclofenac suppository is more effective than IV paracetamol inrelieving postoperative pain. However paracetamol is definitely a viable alternative to the NSA IDs,especially because of the lower incidence of adverse effects, and should be the preferred choice inhigh-risk patients. It may be appropriate to combine paracetamol with NSAIDs,but future studies arerequired especially after major surgery. JBSA 2022; 35 (2) : 37-42

Incidence of and modifiable risk factors for inadequate epidural analgesia in pediatric patients aged up to 8 years.

Postoperative pain in pediatric patients is one of most inadequately treated conditions. This study aimed to investigate the incidence of and modifiable risk factors for inadequate epidural analgesia in pediatric patients aged up to 8 years at Siriraj Hospital-Thailand's largest national tertiary referral center. This retrospective study included pediatric patients aged 0-8 years who underwent surgery with epidural catheter during January 2015 to January 2020. Patients with missing data were excluded. Records from both the ward staff and the acute pain service were reviewed. All relevant data were extracted until the epidural catheters were removed. One hundred and fifty pediatric patients were included. The median age was 29 months and the range varied from 12 days to 98 months on the day of surgery, and 86 (57.3%) were male. The incidence of inadequate epidural analgesia was 32%. Most patients (95.8%) had an unacceptably high pain score within 4 hours after arriving at the ward. Univariate analysis revealed direct epidural placement, the length in epidural space less than 5 cm, and postoperative leakage to be substantially higher in the inadequate pain epidural analgesia group. When those factors were included in multivariate analysis, only length in epidural space less than 5 cm was identified as an independent risk factor. The incidence of inadequate epidural analgesia in this pediatric study was 32%. Multivariate analysis showed length of catheter in epidural space less than 5 cm to be the only factor independently associated with inadequate epidural analgesia.

Gabapentin Premedication to Reduce Postoperative Pain for Pediatric Tonsillectomy/Adenoidectomy: A Pilot Study

PurposeTo examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization. DesignThis randomized, controlled pilot study enrolled patients age 3–18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A. MethodsBoth gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively. FindingsForty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13.Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67–0.97]).Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 – 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory. ConclusionsWe were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiates. Identifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.

Effect of dexmedetomidine on emergence delirium and recovery parameters with sevoflurane and desflurane anaesthesia in children : a double randomized study

Background: Emergence delirium in pediatric patients is a significant cause of increased anxiety among parents. The incidence of emergence delirium in children varies mainly according to the anesthetic agents used. Methods: In this prospective, double-blind, randomized trial, 152 children of age group 1-6 years were randomized into two groups after induction of anesthesia: Group S received Sevoflurane, and Group D received Desflurane. Children in the S group were further randomized into subgroup S- Dex (receiving dexmedetomidine 0.3 mcg/kg in 5 ml saline) and subgroup S-Saline (receiving saline 5 ml). Similarly, Group D was also randomized into two subgroups; D-Dex and D-Saline. We compared perioperative hemodynamic variables, postoperative emergence delirium, recovery profile, pain scoring, the requirement of rescue analgesics, and time to discharge. Results: At 5, 15, and 30 minutes, the incidence of emergence delirium was significantly higher in S-Saline and D-Saline groups than S-Dex and D-Dex groups. Both PAED and FLACC scores were significantly higher in the S-Saline group than the S-Dex group and the D-Saline group compared to the D-Dex group (P&lt;0.05). Significantly more patients required analgesia in the S-Saline group than in the S-Dex group (P&lt;0.05). No significant difference for analgesia was present between D-Saline and D-Dex groups. (p = 0.153). Discharge time was significantly longer in S-Dex and D-Dex groups as compared to S-Saline and D-saline groups. Conclusions: Dexmedetomidine effectively reduced the incidence of emergence delirium and postoperative pain in pediatric patients undergoing surgery using Sevoflurane and Desflurane anesthesia.

The Effects of Designing an Educational Animation Movie in Virtual Reality on Preoperative Fear and Postoperative Pain in Pediatric Patients: A Randomized Controlled Trial

PurposeThe purpose of the study was to investigate the effects of watching an educational animated movie on fear and pain in children aged 6 to 12 years old. DesignA randomized controlled trial. MethodsIn this study, the CONSORT checklist was used as a guide. The sample of participants (n = 132) was allocated to the Educational Animation Group (n = 44), Documentary Group (n = 44), and Control Group (n = 44) using block randomization. During the data collection, an information form, the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale were used. FindingsPreoperative fear and postoperative pain scores were significantly lower in the Educational Animation group than in the other groups. ConclusionsThe educational animated movie was found to be an effective method in reducing preoperative fear and postoperative pain. Educational animated movies, which were effective in reducing the fear and pain of the child in the preparatory operations, increased the educational effectiveness and cooperation of the child.

Ultrasound Verification of Laparoscopic-Assisted Transversus Abdominis Plane Blocks in Children Undergoing Laparoscopic Procedures

Purpose: Ultrasound-guided transversus abdominis plane (TAP) blocks have been demonstrated to decrease postoperative pain; however, laparoscopic-assisted TAP (L-TAP) blocks have not been well studied in children. Our study utilized intraoperative ultrasound to verify whether surgeon-administered blocks using only laparoscopic visualization were reliably delivered into the correct plane. Materials and Methods: Patients undergoing laparoscopic procedures were enrolled to receive L-TAP blocks. Preblock and postblock ultrasounds were performed to document the plane of local anesthetic delivery. Ultrasound images were reviewed by two blinded anesthesiologists to determine whether the L-TAP block was administered into the desired plane. Results: Fifty-one patients were enrolled. The average age was 5.9 years (range: 2 days to 17 years) and the mean weight was 25.4 kg (range: 2.64-118.8 kg). The most common procedures were inguinal hernia repair (n = 19), appendectomy (n = 10), and gastrostomy-tube placements (n = 13). Nine surgeons performed 93 L-TAP blocks (average: 10.3 blocks/surgeon). Ultrasound confirmed distribution in the correct plane in 53.5/93 blocks (57.5%; 58.0% for attending surgeons), with 77.4% concurrence between the anesthesiologist reviewers. Conclusion: L-TAP achieves delivery of local anesthetic into the correct tissue plane in over half the cases with minimal training. Further studies are needed to examine the effect of L-TAP blocks on reducing postoperative pain in pediatric patients.