Postoperative Pain Management in Pediatric Patients Undergoing Cardiac Surgery: Where Are We Heading?

2019 ◽  
pp. 088506661987143 ◽  
Author(s):  
Uri Pollak ◽  
Ronald A. Bronicki ◽  
Barbara-Jo Achuff ◽  
Paul A. Checchia
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Postoperative Pain Management ◽  
Routes Of Administration ◽  
Innovative Methods ◽  
Short And Long Term ◽  
Data Source

Objectives: Adequate postoperative pain management is crucial in pediatric patients undergoing cardiac surgery because pain can lead to devastating short- and long-term consequences. This review discusses the limitations of current postoperative pain assessment and management in children after cardiac surgery, the obstacles to providing optimal treatment, and concepts to consider that may overcome these barriers. Data Source: MEDLINE and PubMed. Conclusions: Effective pain management in infants and young children undergoing cardiac surgery continues to evolve with innovative methods of both assessment and therapy using newer drugs or novel routes of administration. Artificial intelligence– and machine learning–based pain assessment and patient-tailored management in both pain measurement and prevention are already being integrated into the routine of current practice.

scholarly journals Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

2018 ◽  
Vol 21 (3) ◽  
pp. 333 ◽  
Author(s):  
PS Nagaraja ◽  
KarthikNarendra Kumar ◽  
RavikumarNagashetty Kalyane ◽  
NaveenG Singh ◽  
Madhu Krishna ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Management ◽  
Postoperative Pain ◽  
Nerve Block ◽  
Postoperative Pain Management

Acute Pain Management

2018 ◽  
Author(s):  
Nihar Patel
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Treatment Options ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Age Appropriate ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

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. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: The role of intercostal block

2013 ◽  
Vol 48 (12) ◽  
pp. 2425-2430 ◽  
Author(s):  
Laura Lukosiene ◽  
Danguole Ceslava Rugyte ◽  
Andrius Macas ◽  
Lina Kalibatiene ◽  
Dalius Malcius ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pediatric Patients ◽  
Postoperative Pain Management ◽  
Intercostal Block

scholarly journals Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
S. Nardi-Hiebl ◽  
L. H. J. Eberhart ◽  
M. Gehling ◽  
T. Koch ◽  
T. Schlesinger ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
New Technologies ◽  
New Products ◽  
Pharmaceutical Research ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Human Errors ◽  
Routes Of Administration ◽  
Quo Vadis

This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.

scholarly journals Postoperative Pain Management

2021 ◽  
Vol 16 (SP1) ◽  
pp. 5-17
Author(s):  
Yusuke Mazda ◽  
Sandra Jadin ◽  
James S. Kahn
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Management Strategies ◽  
Postoperative Pain Management ◽  
Douleur Postopératoire ◽  
Basic Understanding ◽  
Interventional Pain Management ◽  
Short And Long Term

ABSTRACTAfter surgery, over 80% of people experience moderate-to-severe acute pain. Poorly controlled postoperative pain limits recovery and is associated with detrimental short- and long-term morbidity. While surgeons have traditionally been responsible for postoperative pain management, all clinicians providing care for surgical patients have a basic understanding of common pharmacologic and interventional pain management strategies. In this review, we discuss the consequences of acute pain, approaches to pain assessment, and an overview of commonly used therapies to manage postoperative pain. RÉSUMÉAprès une opération, plus de 80 % des gens ressentent des douleurs aiguës modérées à intenses. Une douleur postopératoire mal maîtrisée limite le rétablissement et est associée à une morbidité défavorable à court et à long terme. Bien que les chirurgiens soient habituellement responsables du traitement de la douleur postopératoire, il est impératif que tous les cliniciens qui soignent des patients ayant subi une intervention chirurgicale aient une connaissance de base des stratégies pharmacologiques et interventionnelles courantes relatives au traitement de la douleur. Dans cette revue, nous abordons les conséquences de la douleur aiguë, les approches de l’évaluation de la douleur et un aperçu des traitements couramment utilisés pour traiter la douleur postopératoire.

POST-OPERATIVE PATIENT-CONTROLLED ANALGESIA

2021 ◽  
Vol 21 (3) ◽  
pp. 280-284
Author(s):  
O.O. Pochynok ◽  
I.A. Kuchynska ◽  
D.O. Dziuba
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Pharmacokinetic Profile ◽  
Modern Method ◽  
Patient Controlled Analgesia ◽  
Routes Of Administration ◽  
Post Operative Pain ◽  
Poor Treatment ◽  
Keyword Searching

Background. Unsatisfactory cases of pain management resulted in poor treatment outcomes have been reported in the last quarter of XX century and unfortunately the number of the cases is not decreasing nowadays. Moderate or severe pain are critical causes of complications, increase in morbidity and mortality in the postoperative period after surgical procedures. Patient-controlled analgesia (PCA) is an effective strategy for postoperative pain management as it may provide suitable analgesic dose just after system activation thus reducing periods of pain and an increasing patients’ satisfaction. The purpose of this study is to elucidate the optimal and modern method of postoperative pain-controlled pain managements. Materials and methods. The study material was selected by keyword searching throughout databases Google, PubMed, journal "Anaestesia and Analgesia". Keywords entered into the database search boxes were as following: "patient- controlled analgesia", "postoperative anesthesia", "postoperative anesthesia". The study provides the lattest approaches, benefits and shortcomings in post-operative pain management. Conclusions. Ptient-controlled analgesia is a promisitng mode to control acute pain. A few advantages of this technique can be distinguished, for example, a higher analgesic level with a patient's satisfactions. Today, there is still no single opinion on which way or medicine is the best to be used in clinical practice because clinical efficiency / safety depends on a complex understanding of the pharmacokinetic profile of medicines for various routes of administration. In addition, pharmacoeconomic research is needed to assess the economic efficiency of these approaches.

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