Pain outcomes in children who received intrathecal vs intravenous opioids for pain control following major urologic surgery: a retrospective review

Putnam, Elizabeth M.; Koppera, Prabhat; Malviya, Shobha; Voepel‐Lewis, Terri

doi:10.1111/pan.12781

Cited by 3 publications

(14 citation statements)

References 18 publications

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“…The application of medical treatment methods in treating postoperative pain in children who underwent ureteroneocystostomy surgery is limited. The use of opioids in the relief of this pain is limited in children [4]. The use of non-steroidal anti-inflammatory drugs increases the risk in this patient group due to the possibility of potential renal damage.…”

Section: Efficacy Of Ultrasound-guided Transversalis Fascia Plane Block In Pediatric Ureteroneocystostomy Surgerymentioning

confidence: 99%

“…Caudal analgesia is one of these methods and provides adequate postoperative analgesia. However, carries risks such as dural puncture, drug administration to the subarachnoid space, constipation, or hypotension [4]. In addition, it is a limited method because it requires a lateral decubitus position for the procedure and premature closure of the hiatus sacralis in some children.…”

Section: Efficacy Of Ultrasound-guided Transversalis Fascia Plane Block In Pediatric Ureteroneocystostomy Surgerymentioning

confidence: 99%

“…Currently, there are limited medical treatments available for managing postoperative pain in children undergoing ureteroneocystostomy surgery, particularly since the use of opioids is restricted in children [ 4 ]. Additionally, the use of non-steroidal anti-inflammatory drugs increases the risk of potential renal damage in this patient group.…”

mentioning

confidence: 99%

“…Caudal analgesia is one available method that provides adequate postoperative analgesia. However, it is associated with risks, such as dural punture, drug administration to the subarachnoid space, constipation, and hypotension [ 4 ]. In addition, the patient must be in a lateral decubitus position for administration and the hiatus sacralis may close prematurely in some children.…”

mentioning

confidence: 99%

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Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery

Peksoz¹,

Yayık

Çelik³

2022

Korean J Anesthesiol

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Section: Efficacy Of Ultrasound-guided Transversalis Fascia Plane Block In Pediatric Ureteroneocystostomy Surgerymentioning

confidence: 99%

Section: Efficacy Of Ultrasound-guided Transversalis Fascia Plane Block In Pediatric Ureteroneocystostomy Surgerymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery

Peksoz¹,

Yayık

Çelik³

2022

Korean J Anesthesiol

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“…Pruritus is one of the most common and bothersome side effects of intrathecal morphine in children, with a reported incidence of 30%-60%. [1][2][3] In a retrospective review of intrathecal morphine for urologic surgery in children, a study from our institution found a 40% incidence of pruritus. 2 Clinicians who have witnessed unbearable itching and scratching in their young patients after intrathecal morphine may be reluctant to offer this effective pain control to future patients for fear of these unpleasant sequelae.…”

Section: Introductionmentioning

confidence: 98%

Intravenous ondansetron reduced nausea but not pruritus following intrathecal morphine in children: Interim results of a randomized, double‐blinded, placebo‐control trial

Putnam

Hong

Park

et al. 2022

Pediatric Anesthesia

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Study Objective: This study's purpose was to determine if ondansetron can prevent pruritus after administration of intrathecal morphine in children, as has been demonstrated in adults.Design: A double-blinded, randomized placebo-controlled trial.Setting: Operating room and first 24 h postoperative inpatient stay at an academic children's hospital.Patients: Forty-six children aged 3-17 years, who received 4-5 mcg/kg intrathecal morphine for urological or orthopedic procedures were included. Interventions:Children were randomized to receive intravenous ondansetron (treatment) or saline placebo (placebo), prior to intrathecal morphine administration, and q6H for 24 h thereafter. Intraoperative anti-emetics and postoperative rescue treatments for pruritus and nausea were standardized.Measurements: Patients were interviewed q6H for scored pruritus, nausea, and pain, using standardized scales. Main Results:The trial was terminated for futility after interim analysis. Forty-six children were recruited and 45 completed data collection. No significant difference was found between both groups for incidence of pruritus (requiring treatment) [relative risk (RR) 0.9, 95% CI: 0.7, 1.2], during the first postoperative 24 h. Notably, the incidence of pruritus was 84% overall, much higher than rates in previously published studies. Intravenous ondansetron significantly reduced the incidence of nausea, compared with the placebo group [RR 0.5, 95% CI: 0.3, 0.9]. Conclusions:This study found no evidence for intravenous ondansetron as an effective preventative for pruritus following intrathecal morphine in children. However, this RCT did find that the rate of pruritus following intrathecal morphine administration may be significantly higher than previously thought. Nausea and vomiting (a secondary outcome) were reduced significantly in the treatment group. The negative

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A Randomized Controlled Trial of Intrathecal versus Caudal Morphine-Bupivacaine on Postoperative Analgesia and Cortisol Levels in Pediatric Patients

Pangasa,

Subramaniam,

Singh

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Morphine is commonly used in pediatric caudal blocks. We compared the analgesic efficacy and effect on cortisol levels of intrathecal morphine and bupivacaine with caudal morphine and bupivacaine in children undergoing lower abdominal surgeries. METHODS: Forty children undergoing lower abdominal surgeries were randomized to receive 4 μg/kg of intrathecal morphine and 0.5% hyperbaric bupivacaine (n = 20), or caudal morphine 40 μg/kg and 0.25% bupivacaine (n = 20). Postoperative analgesia was provided with intravenous (IV) paracetamol (PCM). The primary outcome was time to reach Face, Legs, Activity, Cry, and Consolability (FLACC) score ≥4 postoperatively. Secondary outcomes were perioperative serum cortisol levels, analgesic requirement, and parent satisfaction. RESULTS: Since seventy 5% of patients receiving intrathecal morphine and bupivacaine did not reach a FLACC score ≥4 within 24 hours, the primary outcome was presented as the Kaplan-Meier curve. The probability of FLACC score <4 was significantly higher with intrathecal morphine and bupivacaine than with caudal morphine and bupivacaine (P < .001). The unadjusted and adjusted (for gender) hazard ratio (95% confidence interval [CI]) of occurrence of pain (FLACC score ≥4) was 0.07 (0.03–0.15, P < .001) and 0.06 (0.03–0.14, P < .001), respectively. The difference in means (95% CI) of cortisol levels between caudal morphine (with bupivacaine) and intrathecal morphine (with bupivacaine) groups were after intubation −0.667 (−4.99 to 3.65, P = .76), at 2 hours intraoperatively 7.88 (3.55–12.2, P < .001), 6 hours postoperatively 16.8 (12.5–21.1, P < .001), and 24 hours postoperatively 15.4 (11.1–19.7, P < .001) μg/dL. Intraoperatively, rescue fentanyl was required by 60% of patients on caudal morphine and bupivacaine against 20% of patients receiving intrathecal morphine and bupivacaine (absolute risk-reduction [95% CI] of 40% [12%–68%]; P = .010). Postoperative rescue fentanyl was required in 45% of patients on caudal morphine and bupivacaine and 5% of patients on intrathecal morphine and bupivacaine. All (100%) patients on caudal morphine and bupivacaine required postoperative PCM against 6 (30%) patients on intrathecal morphine and bupivacaine (absolute risk-reduction [95% CI] of 70% [50%–90%]; P < .001). The median (interquartile range [IQR]) parent satisfaction score for patients on caudal morphine (with bupivacaine) and intrathecal morphine (with bupivacaine) was 0(0–0) and 2(2–2) at 12 hours postoperatively (P < .001) and 0(0–1) and 2(1.5–2) at 24 hours postoperatively (P < .001). One patient in each group developed nausea and vomiting, and 1 patient in the intrathecal group developed pruritus. There was no incidence of respiratory depression. CONCLUSIONS: Intrathecal morphine and bupivacaine results in longer duration of analgesia, lower analgesic consumption, prevents surgical-stress-related elevation of serum cortisol, and improves parent satisfaction compared to caudal morphine with bupivacaine in children undergoing lower abdominal surgeries.

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Pain outcomes in children who received intrathecal vs intravenous opioids for pain control following major urologic surgery: a retrospective review

Abstract: We observed better postoperative pain control in children who received IT vs IV opioids for the first 16 h with no discernible difference thereafter. The intrathecal group experienced higher incidences of pruritus, constipation, and hypotension.

Cited by 3 publications

References 18 publications

Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery

Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery

Intravenous ondansetron reduced nausea but not pruritus following intrathecal morphine in children: Interim results of a randomized, double‐blinded, placebo‐control trial

A Randomized Controlled Trial of Intrathecal versus Caudal Morphine-Bupivacaine on Postoperative Analgesia and Cortisol Levels in Pediatric Patients

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