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A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children
Yang Liu1, Catherine Seipel, Monica E Lopez
1Department of Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Insights
A new pain management strategy significantly reduced substantial pain after pediatric laparoscopic appendectomy. This multimodal approach combined local anesthetic, patient-controlled analgesia (PCA) opioids, and scheduled medications, lowering pain incidence from 33% to 12%.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Laparoscopic appendectomy in children often results in significant postoperative pain.
- A substantial percentage of patients experience pain scores greater than 4.
- Effective pain management is crucial for pediatric surgical recovery.
Purpose of the Study:
- To evaluate a multimodal pain management regimen for pediatric laparoscopic appendectomy.
- To assess the impact of combined interventions on postoperative pain control.
- To compare pain outcomes between simple appendicitis and appendicitis with generalized peritonitis.
Main Methods:
- Retrospective study of 206 pediatric patients (age >7) undergoing laparoscopic appendectomy.
- Implemented a pain management bundle: local anesthetic infiltration, IV opioid PCA, scheduled IV ketorolac, and oral acetaminophen/hydrocodone.
- Patients categorized into simple appendicitis and appendicitis with generalized peritonitis groups.
Main Results:
- The multimodal regimen reduced the incidence of substantial pain to 12%, a significant decrease from previous reports (P < 0.001).
- Patients with generalized peritonitis reported higher pain levels, consumed more opioids, and had more unmet PCA demands.
- A higher incidence of respiratory depression was observed in patients with generalized peritonitis.
Conclusions:
- The multimodal pain management strategy effectively reduced substantial pain after laparoscopic appendectomy in children.
- Further research is needed to identify patient subgroups who may benefit from modified pain management protocols.
- This approach offers a promising strategy for improving pediatric surgical pain control.
Background:
Laparoscopic appendectomy is a common emergency pediatric surgery procedure accompanied by substantial pain (pain scores >4 for >60% of the time) in 33% of these patients. We introduced a bundle of pain management interventions including local anesthetic infiltration at the incision site, intravenous (IV) opioids by patient-controlled analgesia (PCA), and scheduled doses of IV ketorolac and oral acetaminophen/hydrocodone.
Objectives:
To evaluate the effect of these pain management interventions on pain control after laparoscopic appendectomy.
Methods:
We retrospectively studied pain in 206 children above 7 years of age undergoing laparoscopic appendectomy from December 2011 to February 2012 at our institution. We extracted data on patient demographics, duration of anesthesia and surgery, intraoperative opioids, local anesthetic infiltration, surgical procedure reports, along with pain scores, postoperative PCA use, and opioid-related complications and hospital stays. Patients were divided into two groups - simple appendicitis without peritonitis and appendicitis with generalized peritonitis.
Results:
The incidence of substantial pain when the multimodal regimen was used was 12%, which is significantly lower than earlier reports (Fisher's exact test P < 0.001). Patients with generalized peritonitis experienced more pain, consumed more opioids, had more unmet PCA demands, and a higher incidence of respiratory depression compared with those with simple appendicitis.
Conclusion:
The multimodal regimen of local anesthetic infiltration, opioid by PCA, NSAIDs, and oral acetaminophen/hydrocodone reduced the incidence of substantial pain. Additional studies are required to identify subgroups of patients with minimal opioid requirements who can benefit from modifications of this regimen.
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