Post-operative non-steroidal anti-inflammatory drug use for pain in infant and paediatric cardiac surgery patients

Abstract

Background:Pain control is an important element of care for patients after surgery, leading to better outcomes, quicker transitions to recovery, and improvement in quality of life. The purpose of this study was to evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs in children after cardiac surgeryMaterials and Methods:Patients between the ages of 1 month and 18 years of age, who received intravenous or oral non-steroidal anti-inflammataory drugs after cardiac surgery, from November 2015 until September 2017 were included in this study. The primary endpoints were non-steroidal anti-inflammataory drug-associated renal dysfunction and post-operative bleeding. Secondary endpoints examined the effect of non-steroidal anti-inflammataory drug use on total daily dose of narcotics, number of intravenous PRN narcotic doses received, and pain assessment score. Data were analysed using descriptive statistics for frequencies and ranges. Multivariate analysis was performed to measure the association of all predictors and outcomes. Wilcoxon singed-rank test was performed for secondary outcomes.Results:There was no association between the incidence of renal dysfunction and the use of or duration of non-steroidal anti-inflammataory drugs; in addition no association was found with increased chest tube output. There was a statistically significant reduction of patients’ median Face, Legs, Activity, Cry, Consolability (FLACC) scores (2–0; p = 0.003), seen within first 24 hours after initiation of ketorolac, and a significant reduction of morphine requirements seen from day 1 to day 2 (0.3 mg/kg versus 0.1 mg/kg; p < 0.001) and number of as-needed doses.Conclusion:Non-steroidal anti-inflammataory drugs in paediatric cardiac surgery patients are safe and effective for post-operative pain management.

The music video therapy in postoperative analgesia in preschool children after cardiothoracic surgery

“…23 Effective pain management can make children get rid of pain earlier after cardiothoracic surgery, promote heart function recovery, shorter hospital stay, and reduce complications. 24 The primary nonpharmaceutical intervention therapy for postoperative pain is a distraction, which refers to transferring patients' attention to other things to reduce patients' pain. 25 Sunitha and his team showed that music therapy was an effective assistant method to reduce the postoperative pain of children undergoing major surgery in their study.…”

“…If pain is not adequately treated, it can also be harmful to psychological and physical health, especially for children 23 . Effective pain management can make children get rid of pain earlier after cardiothoracic surgery, promote heart function recovery, shorter hospital stay, and reduce complications 24 …”

Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

“…NSAIDs also contribute to postoperative pain management in fast-track pediatric cardiac surgery programs, as was proven for ibuprofen, diclofenac, and ketorolac [98][99][100].…”

“…NSAIDs such as diclofenac play an important role in fast-track pediatric cardiac surgery due to their opioid-sparing effect, as was demonstrated in 54 patients with a median age of 5.6 years [ 98 ]. Ketorolac reduced morphine requirements after cardiac surgery in 67 infants (median age 22.7 months) within 24 h after its first administration [ 99 ]. The safe use of ketorolac has been demonstrated in neonates and infants [ 146 ], however special caution is needed when NSAIDs are used in combination.…”

Efficiency and safety of pharmacotherapy for postoperative pain in cardiac surgery

“…Несмотря на возрастные ограничения применения НПВП, эффективность и безопасность этой группы препаратов продемонстрирована в зарубежных источниках и у детей. По данным Savva DA, et al (2019) при анальгезии кеторолаком у детей пос ле кардиохирургических вмешательств в возрасте от 1 мес. до 18 лет отмечалось статистически значимое снижение интенсивности БС по шкале FLACC (Face, Legs, Activity, Cry, Consolability -лицо, ноги, активность, крик, утешительность) (0-2 балла, р=0,003) в течение первых 24 ч послеоперационного периода, а также снижение потребности в морфине (p<0,001) [35].…”