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.
nerve block
pain management
pain, postoperative
pediatrics
regional anesthesia
Journal
Regional anesthesia and pain medicine
ISSN: 1532-8651
Titre abrégé: Reg Anesth Pain Med
Pays: England
ID NLM: 9804508
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
05
06
2022
accepted:
15
09
2022
pmc-release:
01
01
2024
pubmed:
28
9
2022
medline:
26
11
2022
entrez:
27
9
2022
Statut:
ppublish
Résumé
Regional 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 bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery. A retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight. 158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34-51) for no regional to 64 min (IQR 40-97) for regional catheters (p<0.01). The regional catheter group had lower median intraoperative opioid usage (0.24 vs 0.80 mg/kg morphine equivalents, p<0.01) as well as lower in-hospital postoperative opioid usage (0.05 vs 0.23 mg/kg/day morphine equivalents, p<0.01). Pain scores were not higher in the regional catheters group. Continuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population. NCT03245242.
Identifiants
pubmed: 36167478
pii: rapm-2022-103823
doi: 10.1136/rapm-2022-103823
pmc: PMC10026848
mid: NIHMS1877238
doi:
Substances chimiques
Analgesics, Opioid
0
Morphine
76I7G6D29C
Banques de données
ClinicalTrials.gov
['NCT03245242']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
29-36Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK125670
Pays : United States
Investigateurs
Yvonne Y Chan
(YY)
Dominic Frimberger
(D)
C D Anthony Herndon
(CD)
Adam J Rensing
(AJ)
Bhalaajee Meenakshi-Sundaram
(B)
Paul A Merguerian
(PA)
Erica J Traxel
(EJ)
Brian VanderBrink
(B)
Vijaya M Vemulakonda
(VM)
Douglas E Coplen
(DE)
Timothy P Welch
(TP)
Duncan T Wilcox
(DT)
Elizabeth B Yerkes
(EB)
Carter J Sevick
(CJ)
Informations de copyright
© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: KOR is a site investigator for AbbVie.
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