scholarly journals Current Trends in Pediatric Spine Deformity Surgery: Multimodal Pain Management and Rapid Recovery

2019 ◽  
Vol 10 (3) ◽  
pp. 346-352
Author(s):  
Sagar A. Shah ◽  
Richard Guidry ◽  
Abhishek Kumar ◽  
Tyler White ◽  
Andrew King ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Recovery Time ◽  
Postoperative Pain Management ◽  
Opioid Consumption ◽  
Rapid Recovery ◽  
Spine Deformity ◽  
Pediatric Spine ◽  
Pubmed Database ◽  
Scoliosis Correction

Study Design: Narrative review. Objectives: The purpose of this article is to perform a review of the literature assessing the efficacy of opioid alternatives, multimodal pain regimens, and rapid recovery in pediatric spine surgery. Methods: A literature search utilizing PubMed database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease postoperative pain and expedite recovery after posterior spinal fusion in adolescent idiopathic scoliosis patients have been provided based on results of studies with the highest level of evidence. Results: Refining perioperative pain management to lessen opioid consumption with multimodal regimens may be useful to decrease recovery time, pain, and complications. Nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin, neuraxial blockades, and local anesthesia alone offer benefits for postoperative pain management, but their combination in multimodal regimens and rapid recovery pathways may contribute to faster recovery time, improved pain levels, and lower reduction in total opioid consumption. Conclusion: A rapid recovery pathway using the multimodal approach for pediatric scoliosis correction may offer superior postoperative pain management and faster recovery than traditional opioid only pain protocols.

scholarly journals Expanding the Perisurgical Home to Improve Postoperative Pain Management and Reduce Opioid Consumption

2019 ◽  
Vol 19 (2) ◽  
pp. 68-69
Author(s):  
Ivan Urits ◽  
Omar Viswanath ◽  
Vwaire Orhurhu ◽  
Viet Cai ◽  
Musa Aner
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Opioid Consumption

Addition of Intrathecal Morphine for Postoperative Pain Management in Pediatric Spine Surgery

2019 ◽  
Vol 32 (3) ◽  
pp. 104-110 ◽  
Author(s):  
Arif Musa ◽  
Frank L. Acosta ◽  
Alexander Tuchman ◽  
Rana Movahedi ◽  
Kasim Pendi ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Spine Surgery ◽  
Intrathecal Morphine ◽  
Postoperative Pain Management ◽  
Pediatric Spine

scholarly journals Pre-emptive analgesia : effect of low dose Ketamine as pre-emptive analgesia in postoperative pain management after lower abdominal surgery

2014 ◽  
pp. 17-22
Author(s):  
Sajjad Ahmed ◽  
Md Mozaffer Hossain ◽  
UH Shahera Khatun
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Pain Intensity ◽  
General Anaesthesia ◽  
Low Dose ◽  
Neuromuscular Block ◽  
Postoperative Pain Management ◽  
Opioid Consumption ◽  
Controlled Study

A Prospective randomized placebo-controlled study was done at Dhaka Medical College Hospital to evaluate the effects of low dose Ketamine as preemptive analgesia in post operative pain management after lower abdominal surgery. Sixty patients scheduled for elective total abdominal hysterectomy under General Anaesthesia were randomly divided into three equal groups. In Group-A, patients received 0.5 mg/kg ketamine I/V 90 seconds before incision, in Group-B, patients received the same dose after incision and in Group-C, patients were regarded as controlled, received 0.5 ml distilled water before incision. The patients were premedicated orally by giving Tab. diazepam 5mg with sips of water one hour before induction of anaesthesia. General anaesthesia was induced with thiopental sodium 3-5 mg/kg. Suxamethonium 1.5 mg/kg was given to facilitate endotracheal intubation. The neuromuscular block was continued with vecuronium. Anaesthesia was maintained with N20 (60-70%) and halothane in 02. Halothane was adjusted to maintain the MAP and heart rate within 20% of the pre-induction value. Opioids were not administered during the induction or during the operation. At the end of the anaesthesia, residual neuromuscular block was antagonized with intravenous neostigonine 0.05 mg/kg in atropine 0.02 mg/kg. In the post operative ward following parameters were recorded for 24 hours: recovery status, time of first analgesic demand, pain intensity by VAS & VRS, total opioid consumption, sedation score, haemodynamic status and, complications like nausea, vomiting, delirium and hallucination. Upon the first complaint of moderate pain (>5 on VAS), pethidine 1.5 mg/kg was administered intramuscularly & then repeated 4 hourly. If pain intensity remained >5 on VAS scale, rescue analgesic Pethidine 10 mg was administered intravenously. Time of first demand for analgesic among three groups: Gr- A( preincision): 68.4 ± 6 min; Gr-B (post-incision): 37.4 ± 3.3 min; and Gr-C (Control): 18.9 ± 2.1 min. It is statistically significant (P<0.00) i, e, delayed in Gr. A. Total opioid consumption in 24 hours was: Gr. A: 8.6 ± 0.11 mg/kg, Gr. B: 9.0 ± 0.11 mg/kg and in Gr. C: 9.9 ± 0.14 mg/kg. (P<0.00) i.e. less in Gr. A. The incidence of hallucination and delirium were present in Gr. A & Gr. B but more in Gr. B than Gr. A. Nausea and vomiting were present in three groups. So, it can be concluded that preemptive use of ketamine significantly reduces postoperative pain and spare opioid consumption in the postoperative pain management. Journal of BSA, Vol. 17, No. 1 & 2, 2004 p.17-22DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4046

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