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Published on: April 17, 2020
Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and
C Chauvin1, A S Schalber-Geyer1, F Lefebvre2
1Department of Anesthesia and Critical Care, Hôpital Hautepierre-CHU Strasbourg, Strasbourg, France.
Insights
Early oral fluid intake in young children after surgery significantly reduced opioid use and postoperative vomiting. This simple intervention improves recovery for pediatric day case patients.
Area of Science:
- Pediatric Anesthesiology
- Postoperative Care
- Pain Management
Background:
- Distinguishing causes of distress in young children (under 4 years) post-surgery is challenging.
- This can lead to inappropriate treatments like opioid administration.
- Early oral fluid intake may mitigate these issues.
Purpose of the Study:
- To evaluate the impact of early oral fluid intake on opioid analgesic use.
- To assess the effect on postoperative vomiting (POV) incidence.
- Focus on pediatric day case surgery patients.
Main Methods:
- Randomized controlled trial with 231 patients (6 months to 4 years).
- Liberal Group (LG) received apple juice if FLACC score ≥4 in PACU.
- Control Group (CG) followed standard opioid protocol; fluids allowed on ward return.
- Bayesian analysis compared POV and opioid use.
Main Results:
- POV incidence was 11.40% in LG vs. 23.93% in CG.
- Opioid use was 14.04% in LG vs. 35.89% in CG.
- PACU stay was shorter in LG (53.45 min) vs. CG (65.05 min).
Conclusions:
- Early postoperative oral fluid intake reduced opioid use and POV incidence in pediatric outpatients.
- Findings suggest a potential improvement in recovery.
- Further confirmation in diverse settings is recommended.
Background:
In children younger than 4 yr, it is difficult to distinguish the cause of postoperative distress, such as thirst, pain, and emergence delirium. This may lead to inappropriate treatment, such as administration of opioids. The aim of this study was to evaluate the influence of early postoperative oral fluid intake on the use of opioid analgesics and the incidence of postoperative vomiting (POV) after paediatric day case surgery.
Methods:
After ethics committee approval and with parental informed consent, planned day surgery patients aged 6 months to 4 yr were randomized to the liberal group (LG), in which apple juice (10 ml kg−1) was offered first if the Face Legs Activity Cry COnsolability (FLACC) score was ≥4 in the PACU, or to the control group (CG), in which children were treated after surgery according to the institutional opioid protocol, and drinking was allowed only upon the return to the ward. Bayesian statistical analysis was used to compare POV incidence and opioid use across groups.
Results:
Data from 231 patients were analysed. The incidence of POV in the LG and the CG was 11.40 and 23.93%, respectively. An opioid was needed in 14.04% (mean total dose: 0.18 mg kg−1) and 35.89% (mean total dose: 0.20 mg kg−1) of the patients in the LG and the CG. The PACU stay was 53.45 and 65.05 min in the LG and the CG, respectively (all differences were statistically significant).
Conclusions:
In our paediatric outpatient setting, early postoperative oral fluid intake was associated with a reduction in opioid use and POV incidence. These results deserve confirmation in other settings.
Clinical Trial Registration:
NCT02288650.
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