Enhanced recovery after surgery in paediatrics: a review of the literature

Roberts, Kevin A.; Brindle, Mary; McLuckie, Duncan

doi:10.1016/j.bjae.2020.03.004

Cited by 30 publications

(18 citation statements)

References 30 publications

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“…7 Enhanced recovery after surgery for pediatric patients also advocates the use of adjunctive regional analgesia to minimize intraoperative anesthetics and attenuate harmful surgical stress response. 8 Different regional analgesic techniques have different analgesic effects, durations, and adverse effects. However, previous meta-analyses comparing regional analgesia in pediatric genitourinary surgeries have led to incomplete comparisons and conflicting results.…”

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confidence: 99%

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Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Hung

Bai

Tsai

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis. Methods: We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events. RESULTS: This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies. CONCLUSIONS: The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries. (Anesth Analg 2024;138:108-22) KEY POINTS• Question: Which type of regional analgesia has the longest analgesic duration in pediatric inguinal surgeries? • Findings: The quadratus lumborum block had the longest time to the first rescue analgesic in inguinal hernia repair, whereas the caudal block was the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. • Meaning: The quadratus lumborum block has the...

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confidence: 99%

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Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Hung

Bai

Tsai

et al. 2022

Anesthesia &Amp; Analgesia

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“…With the move to Enhanced Recovery After Surgery becoming more prevalent in pediatrics, allowing an infant to self-limit their intake volume, as well as return to a full-liquid diet, is supported by evidence. Even with infants having much more invasive procedures, allowing early ad libitum feeding has been associated with decreased lengths of stay (Roberts et al, 2020).…”

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confidence: 99%

The Effect of Early Feeding of Full Liquids on Postoperative Infants

Kiolbasa

Chaturvedi

Ryan

et al. 2023

Journal of Pediatric Surgical Nursing

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There is a lack of evidence-based guidance for postoperative feeding of infants after outpatient surgeries. This randomized controlled trial tested the hypothesis that infants, aged ≤12 months who are fed formula or milk at home, will have more oral intake, less pain, and less emergence delirium when fed formula/milk as compared with clear liquids in the postanesthesia care unit. Infants were randomized to receive formula/milk or clear liquids as first feeding after outpatient myringotomy and tube insertion. Pain (Faces, Legs, Activity, Cry, and Consolability) and emergence delirium (Pediatric Anesthesia Emergence Delirium) scores were recorded and compared immediately and again 15 and 30 minutes after arrival in the postanesthesia care unit. Infants randomized to the formula/milk first-feeding group had significantly more volume of oral feeding intake than infants randomized to the clear liquid first-feeding group (M = 80.5 ml, 95% CI [15, 146], p = .017). There was no significant difference in vomiting, pain scores, or emergence delirium scores between groups. These results support the practice of ad lib feeding of infants who preferred full liquids after outpatient surgical procedures.

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“…The questionnaire was designed by referring to experts' consensus (Brindle et al, 2020), and the relevant reviews (Roberts et al, 2020; Rove et al, 2018; Shu & Tou, 2019; Wu et al, 2019). It consisted of three parts corresponding to knowledge, attitudes, and self‐reported practices of ERAS among paediatric surgical nurses.…”

Section: Methodsmentioning

confidence: 99%

Knowledge, attitudes and practices of enhanced recovery after surgery among paediatric surgical nurses in China: A Cross‐Sectional study

Liu

et al. 2022

Nursing Open

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Aim To investigate paediatric surgical nurses' knowledge, attitudes and practices (KAP) regarding enhanced recovery after surgery (ERAS). Design A cross‐sectional study. Methods A 34‐question survey was developed. An electronic version of the questionnaire was distributed to nurses working in paediatric surgical departments of 22 tertiary hospitals from 14 provinces of China by means of convenience sampling from February to April 2021. A total of 855 nurses' data was used as the final sample. The statistical analysis included nonparametric test, Spearman′s correlation and multiple linear regression. Results There is still room for improvement regarding the KAP of paediatric surgical nurses, especially in the knowledge of “postoperative recovery” and “preoperative preparation”. The influencing factors of KAP were educational level, geographical region (South, Central, North, Northwest), years of work experience, hospital category (general hospital, women and children′s hospital), and familiarity with ERAS.

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Enhanced recovery after surgery in paediatrics: a review of the literature

Cited by 30 publications

References 30 publications

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

The Effect of Early Feeding of Full Liquids on Postoperative Infants

Knowledge, attitudes and practices of enhanced recovery after surgery among paediatric surgical nurses in China: A Cross‐Sectional study

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