Related Experiment Videos
Pain management for children following selective dorsal rhizotomy
J M Geiduschek1, C M Haberkern, J F McLaughlin
1Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105.
Insights
Selective dorsal rhizotomy (SDR) pain and spasticity management is effectively handled with continuous morphine and midazolam infusions. Adjunct ketorolac further aids in managing postoperative pain and muscle spasms following SDR procedures.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pediatric Neurology
Background:
- Selective dorsal rhizotomy (SDR) is a surgical intervention for managing lower extremity spasticity in cerebral palsy patients.
- Effective postoperative pain and spasticity management are crucial for patient recovery after SDR.
- Limited data exists on comprehensive pain and spasticity management protocols post-SDR.
Purpose of the Study:
- To review the institution's initial three-year experience with managing postoperative pain and spasticity in patients undergoing SDR.
- To evaluate the efficacy and safety of specific analgesic and anti-spasmodic regimens.
- To establish best practices for postoperative care following SDR.
Main Methods:
- Retrospective review of medical records for 55 patients who underwent SDR.
- Analysis of postoperative pain management strategies, primarily continuous morphine infusions.
- Assessment of muscle spasm management using intravenous benzodiazepines (diazepam or midazolam).
- Inclusion of ketorolac as an adjunct analgesic in select cases.
- Continuous cardiorespiratory monitoring and frequent nursing assessments were standard.
Main Results:
- Continuous morphine infusions were the primary analgesia method for most patients.
- Intravenous midazolam infusions were predominantly used for muscle spasm control.
- Ketorolac was utilized as an adjunct in six patients.
- No episodes of postoperative apnea or excessive sedation were reported.
- The combined regimen of continuous morphine, midazolam, and adjunct ketorolac proved effective.
Conclusions:
- Continuous infusions of morphine and midazolam, supplemented by ketorolac, are effective for managing postoperative pain and muscle spasms after SDR.
- The established protocol ensures safe and effective patient care on a specialized ward.
- This approach contributes to improved patient outcomes following SDR for cerebral palsy.
Abstract:
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used for treating lower extremity spasticity in patients with cerebral palsy. The purpose of this paper is to present a review of our institution's first three years' experience with postoperative pain and spasticity management in patients who have undergone SDR. The medical records of the 55 patients who had an SDR during the study period were reviewed. The basis of postoperative analgesia was morphine, with the majority of patients receiving continuous morphine infusions (20-40 micrograms.kg-1.hr-1 (n = 49), 60 micrograms.kg-1.hr-1 (n = 1)). Four patients used a patient-controlled delivery system. One patient had successful analgesia with epidural morphine. Ketorolac (1 mg.kg-1 i.v. loading dose followed by 0.5 mg.kg-1 i.v. every six hr for 48 hr) was used as an adjunct to morphine in six patients. For management of postoperative muscle spasm, an intravenous benzodiazepine was used (diazepam 0.1 mg.kg-1 (n = 2), or midazolam infusion 10-30 micrograms.kg-1.hr-1 (n = 51)). All patients were cared for on a ward where nurses were familiar with the use of continuous opioid and benzodiazepine infusions. All patients received continuous cardiorespiratory monitoring as well as frequent nursing assessment. There were no episodes of postoperative apnoea or excessive sedation. We have found the use of continuous infusions of morphine and midazolam, along with adjunct ketorolac, to be effective in treating postoperative pain and muscle spasms following SDR.