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Postoperative pain children

Cory M Resnick, Carly E Calabrese, Salim Afshar, Bonnie L Padwa
PURPOSE: Opioid abuse is a public health concern. Oral opioids are prescribed after removal of third molars, but the amount needed for adequate postoperative analgesia is unknown. The purpose of this study was to quantify opioid need after third molar extractions. MATERIALS AND METHODS: This is a prospective cohort study of consecutive patients who had asymptomatic third molars extracted with intravenous sedation at the Boston Children's Hospital (Boston, MA) from June through October 2018 by 3 attending surgeons...
February 16, 2019: Journal of Oral and Maxillofacial Surgery
Christoffer Skov Olesen, Kristoffer Andresen, Stina Öberg, Jacob Rosenberg
BACKGROUND: Regarding groin hernia repair in children, guidelines do not favor open or laparoscopic repair. Even so, most surgeons prefer an open technique. The aim of this systematic review was to compare short- and long-term outcomes after laparoscopic and open groin hernia repair in children. METHODS: Systematic searches were conducted in three databases, and all randomized controlled trials comparing laparoscopic and open groin hernia repair in children under 18 years were included...
March 13, 2019: Surgical Endoscopy
Marion Wiegele, Peter Marhofer, Per-Arne Lönnqvist
Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain...
April 2019: British Journal of Anaesthesia
Myriam Bellon, Daphné Michelet, Nils Carrara, Thomas Vacher, Benjamin Gafsou, Brice Ilhareborde, Keyvan Mazda, Emmanuelle Ferrero, Anne-Laure Simon, Florence Julien-Marsollier, Souhayl Dahmani
PURPOSE: The aim of this study was to investigate the opioid-sparing effect of a cooling brace after surgical correction of idiopathic surgery in children. METHODS: We compared two consecutive cohorts of patients before and after introducing this technique in our institution. Management of patients was standardized. The primary objective of the study was to investigate the morphine consumption during the first postoperative day. Secondary outcomes were opioid consumption at day 3, pain intensity (at days 1 and 3), the mobilization in the standing position and duration of hospitalization...
January 31, 2019: European Spine Journal
D Barbier, D N'Dele, M Bennis, C Thevenin-Lemoine, J Sales De Gauzy, F Accadbled
Purpose: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. Methods: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy...
February 1, 2019: Journal of Children's Orthopaedics
Katherine Lemming, Gary Fang, Marcia L Buck
OBJECTIVES: Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS: A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System...
January 2019: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Jesse Cramer
OBJECTIVE: The use of patient-controlled epidural analgesia (PCEA) in pediatric patients has been shown to be safe and effective in managing postoperative pain in children. However, the optimal opioid to use in the epidural regimen remains undetermined. Morphine, hydromorphone, and fentanyl have been the agents most often used, but comparison of effectiveness across studies is difficult. The goal of this study was to compare postoperative pain scores in patients receiving PCEA solutions that contained either ropivicaine plus morphine or ropivicaine plus hydromorphone...
January 2019: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Nathan J Jacobson, Robert E Van Demark, Bradley Reeves
Osteomyelitis pubis is a rare orthopedic infection, accounting for less than 1-2 percent of all hematogenous osteomyelitis. Osteomyelitis pubis generally affects children, elderly patients who have undergone genitourinary procedures, and parenteral drug users. Interestingly, cases of acute osteomyelitis pubis have also been documented in previously young, healthy athletes. The diagnosis is often difficult to differentiate from osteitis pubis, which is a self-limiting, painful inflammatory condition affecting the symphysis pubis...
December 2018: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Joanne Guay, Santhanam Suresh, Sandra Kopp
BACKGROUND: The use of ultrasound guidance for regional anaesthesia has become popular over the past two decades. However, it is not recognized by all experts as an essential tool, perhaps because it is unclear whether ultrasound reduces the risk of severe neurological complications, and the cost of an ultrasound machine (USD 22,000) is substantially higher than the cost of other tools. This review was published in 2016 and updated in 2019. OBJECTIVES: To determine whether ultrasound guidance offers any clinical advantage when neuraxial and peripheral nerve blocks are performed in children in terms of decreasing failure rate or the rate of complications...
February 27, 2019: Cochrane Database of Systematic Reviews
Ron B Mitchell, Sanford M Archer, Stacey L Ishman, Richard M Rosenfeld, Sarah Coles, Sandra A Finestone, Norman R Friedman, Terri Giordano, Douglas M Hildrew, Tae W Kim, Robin M Lloyd, Sanjay R Parikh, Stanford T Shulman, David L Walner, Sandra A Walsh, Lorraine C Nnacheta
OBJECTIVE: This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall...
February 2019: Otolaryngology—Head and Neck Surgery
Gangshan Liu, Ying Fan
BACKGROUND: Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. METHODS: We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. RESULTS: A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225 min and 0-1200 ml, respectively...
February 14, 2019: World Journal of Surgery
Aaron Alokozai, Sara L Eppler, Laura Y Lu, Nicole Sheikholeslami, Robin N Kamal
BACKGROUND: Forecasting is a construct in which experiences and beliefs inform a projection of future outcomes. Current efforts to predict postoperative patient-reported outcome measures such as risk-stratifying models, focus on studying patient, surgeon, or facility variables without considering the mindset of the patient. There is no evidence assessing the association of a patient's forecasted postoperative disability with realized postoperative disability. Patient-forecasted disability could potentially be used as a tool to predict postoperative disability...
March 2019: Clinical Orthopaedics and related Research
Arvind Chandrakantan, Ruth A Reinsel, Ronald Jasiewicz, Zvi C Jacob, Peggy A Seidman
BACKGROUND: The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric post-discharge nausea and vomiting . AIMS: A preliminary study of the factors affecting post discharge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory. METHODS: 122 pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study...
February 14, 2019: Paediatric Anaesthesia
Jin Li, Zhi Wei, Jie Zhang, Hakon Hakonarson, Scott D Cook-Sather
Acute pain and opioid analgesia demonstrate inter-individual variability and polygenic influence. In 241 children of African American and 277 of European Caucasian ancestry, we sought to replicate select candidate gene associations with morphine dose and postoperative pain and then to estimate dose prediction limits. Twenty-seven single-nucleotide polymorphisms (SNPs) from nine genes (ABCB1, ARRB2, COMT, DRD2, KCNJ6, MC1R, OPRD1, OPRM1, and UGT2B7) met selection criteria and were analyzed along with TAOK3. Few associations replicated: morphine dose (mcg/kg) in African American children and ABCB1 rs1045642 (A allele, β = -9...
February 14, 2019: Pharmacogenomics Journal
Jae Young Ji, Jin Soo Park, Ji Eun Kim, Dah Hyung Kim, Jin Hun Chung, Hea Rim Chun, Ho Soon Jung, Sie Hyeon Yoo
BACKGROUND: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. METHODS: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1...
February 5, 2019: Chinese Medical Journal
Hagar Hassanein Refaee, Amel Hanafy Abo Elela, Maha Gamil Hanna, Mai Ahmed Ali, Amira Mohamed El Khateeb
BACKGROUND: Caudal block remains fundamental in pediatric anaesthetic practice. It is very useful in a wide range of surgical procedures and has proved to have a remarkable safety record, But one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. Prolongation of caudal analgesia using single-shot technique has been achieved by the addition of various adjuvant. AIM: This work aims to compare magnesium and dexmedetomidine as adjuvants to bupivacaine-induced caudal block in children undergoing lower limb orthopaedic surgery...
January 15, 2019: Open Access Macedonian Journal of Medical Sciences
Yang Jiao, Bin He, Xingyu Tong, Ran Xia, Chengmi Zhang, Xueyin Shi
INTRODUCTION: Under-dosage or over-dosage of intraoperative analgesia can cause harm to patients. Many studies have demonstrated the clinical advantages of nociception monitoring tools, but with some conflicting results. To clarify the issue, this meta-analysis compared the effects of analgesia nociception index (ANI), surgical pleth index (SPI), and pupillometry monitoring methods with those of analgesia management practices of intraoperative opioid administration. EVIDENCE ACQUISITION: A comprehensive literature search was conducted to identify clinical trials that compared the effect of monitoring of nociception- antinociception balance (versus clinical signs) on intraoperative opioid administration...
February 7, 2019: Minerva Anestesiologica
Alexander J Adams, Matthew J Buczek, John M Flynn, Apurva S Shah
BACKGROUND: There is a need for improved opioid stewardship in orthopedic surgery through multimodal analgesia strategies. Perioperative administration of ketorolac in children undergoing closed reduction and percutaneous pinning (CRPP) for displaced supracondylar humerus (SCH) fracture may decrease pain, reduce opioid requirements, and decrease hospitalization costs. METHODS: Retrospective case-control investigation of children (aged, 1 to 14) treated with CRPP for closed, modified Gartland type III extension-type SCH fractures at a single children's hospital between 2011 and 2017...
February 1, 2019: Journal of Pediatric Orthopedics
Qiang Wang, Meng-Meng Du, Xin-Jian Pei, Jun-Zhong Luo, Ya-Zhou Li, Yu-Chang Liu, Xuan Wang, Jin-Chao Cao, Jiu-Hui Han
OBJECTIVE: The treatment of missed Monteggia fracture remains a challenge, despite the various surgical methods described. The purpose of this study was to explore a new surgical technique utilizing external fixator-assisted ulnar osteotomy and to assess the surgical results in a case series. METHODS: Thirteen patients with missed Monteggia fractures were treated at our institution using this new surgical technique from August 2012 to January 2016. Our series included 11 boys and 2 girls...
February 4, 2019: Orthopaedic Surgery
R F Wang, Y Lou, K Tang, G P Liu, M C Chen, G Lin
Objective: To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture. Methods: A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children's Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11...
February 1, 2019: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
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