Multimodal analgesia for pediatric patients who underwent open or laparoscopic appendectomy

Abstract

Objective: The aim of this study is to show the results of the implementation of a multimodal pain therapy regimen consisting of preemptive and infiltration analgesia application to laparoscopic or open appendectomy in pediatric patients. Methods: Eighty pediatric patients with diagnosis of acute and perforated appendicitis, who scheduled for laparoscopic or open appendectomy were randomly separated into 2 groups of 40. Age, sex, and weight of the patients, duration of anesthesia and surgical techniques were recorded. Preemptive 1.5 mg/kg tramadol HCl was administered at induction of anesthesia. As infiltration anesthesia 1 mg/kg 0.5% bupivacaine HCl was administered to the incision site of all patients. The pain levels of the patients after extubation were evaluated with Children's Hospital of Eastern Ontorio Pain Scale and Visual Analog Scale. The heart rates, respiratory rates, sedation score values, diastolic and systolic blood pressure values, postoperative analgesic requirements, sedation scores, the observed side effects, hospital stay, and the time of the first mobilization were recorded and compared. Results: There were no statistically significant differences between the groups with respect to monitored parameters except operation time and anesthesia time. Postoperative first day 13 patients (32.5%) in the LA group and in 9 patients (22.5%) in OA group, while on the second day only 2 patients (%5) in the OA group required additional analgesia . Conclusion: Our multimodal analgesia protocol consisting of preemptive analgesia and perioperative local anesthesia infiltration showed no difference between patients who underwent laparoscopic or open appendectomy with respect to pain levels and analgesic requirements.