Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children

Song, In Kyung; Park, Yong‐Hee; Lee, Ji Hyun; Kim, Jin‐Tae; Choi, In Ho; Kim, Hee‐Soo

doi:10.1111/pan.12864

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…In a recent study, Song et al reported that for pediatric patients undergoing corrective osteotomy, preemptive analgesia using intravenous PCA with fentanyl did not significantly affect postoperative pain. 15 However, this study had two key limitations that may explain these negative results. First, they compared the effects of PCA when initiated either just before or after skin incision, conforming to the classic view of preemptive analgesia.…”

Section: Discussionmentioning

confidence: 89%

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Kim

Lee

et al. 2018

JPR

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BackgroundChildren undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.Patients and methodsPatients (N=50, 3–12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours postoperatively.ResultsForty-seven patients completed the study, 23 in the preemptive group and 24 in the control group, respectively. The revised Face, Legs, Activity, Cry, and Consolability pain scores were significantly lower in the preemptive group only at 30 minutes after postanesthesia care unit arrival and 6 hours after surgery (median difference −1.0, 95% CI −2.0 to −1.0, P=0.001 and median difference −2.0, 95% CI −3.0 to −1.0, P=0.005, respectively). However, they were not significantly different between the groups at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements throughout 48 hours postoperatively were not significantly different between the groups.ConclusionIntraoperative epidural infusion of ropivacaine did not demonstrate preemptive analgesic efficacy within 48 hours postoperatively in children undergoing extensive lower limb orthopedic surgery.

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Section: Discussionmentioning

confidence: 89%

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Kim

Lee

et al. 2018

JPR

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“…Acute pain is extremely important to manage well in children, given poorly managed acute pain is a significant factor in the transition from acute to chronic pain and suboptimal pain management can lead to increased pain experience and decreased cooperation in subsequent medical visits . A common medical event involving acute pain is surgery and in fact, millions of children undergo surgery each year in the US and the majority experience significant pain postoperatively . Accordingly, WebTIPS (http://centeronstressandhealth.hs.uci.edu/research_periop.shtml) is an Internet‐based surgical preparation program for children and families that aims to reduce preoperative anxiety and postoperative pain .…”

Section: Mhealth Programs For Pediatric Painmentioning

confidence: 99%

“…,24 A common medical event involving acute pain is surgery and in fact, millions of children undergo surgery each year in the US and the majority experience significant pain postoperatively 4,[25][26][27]. Accordingly, WebTIPS (http://centeronstressandhealth.…”

mentioning

confidence: 99%

Pain relief in the palm of your hand: Harnessing mobile health to manage pediatric pain

Hunter

Kain

Fortier

2018

Pediatric Anesthesia

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Summary The development and implementation of mobile health (mHealth) interventions provide an opportunity for more optimal management of pediatric pain in the home setting. Leveraging the popularity, mobility, and technological capabilities of digital mobile devices may reduce pediatric pain. Several mHealth applications have already been developed that target the reduction of acute and chronic pediatric pain by digitally delivering intervention strategies in an engaging manner, accumulating pain assessment data, facilitating patient‐provider communication, and providing interactive training. Although several mHealth programs have begun to make strides in the management of pediatric pain, there are still many more possibilities for improvement as greater development and adoption of mHealth practices is on the horizon. Recommendations are provided that advocate for continued advancement of pediatric pain mHealth implementation with an emphasis on robust scientific evaluation, a structured approach to development and design elements that enhance engagement. Increased awareness about the positive influence of mHealth along with the encouragement of researchers and healthcare providers to promote and develop mHealth programs has the potential to transform pediatric pain management. This merger of evidence‐based pain management strategies and digital technology positions pediatric mHealth to have a profound impact by effectively augmenting standard of care and benefiting healthcare providers, parents, and especially children in need.

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“…The patients were transferred to the post-anesthetic care unit (PACU) and stayed for at least 30 min for stabilization. We also checked the postoperative pain scale (FLACC scale) [18] and emergence delirium scale (PAED scale) [19] in the PACU.…”

Section: Study Protocolmentioning

confidence: 99%

Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children

Song

Kim

et al. 2017

Anesth Pain Med

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Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children

Abstract: Preemptive analgesia using IV-PCA with fentanyl showed no significant advantages for postoperative analgesia after corrective osteotomy in pediatric patients.

Cited by 13 publications

References 27 publications

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities

Pain relief in the palm of your hand: Harnessing mobile health to manage pediatric pain

Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children

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