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A comparative study of the analgesia requirements following laparoscopic and open fundoplication in children
A C Dick1, P Coulter, A M Hainsworth
1Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Northern Ireland.
Insights
Laparoscopic fundoplication in children requires similar total morphine but less overall analgesia duration compared to open surgery. The key benefit is reduced pain duration post-procedure.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Procedures
- Pain Management
Background:
- Laparoscopic procedures are increasingly used in pediatric surgery.
- Reduced analgesia is a commonly cited benefit of laparoscopic techniques.
- Laparoscopic fundoplication has been introduced as a surgical option.
Purpose of the Study:
- To compare the analgesia requirements between laparoscopic and open fundoplication in children.
- To evaluate the impact of surgical approach on pain management and duration.
Main Methods:
- A comparative analysis of 40 fundoplication procedures (20 laparoscopic, 20 open) was conducted.
- Pain relief data, including morphine and NSAID requirements, were prospectively documented by an independent pain team.
- Data collection was part of an ongoing hospital audit.
Main Results:
- Total morphine analgesia required was similar for both groups.
- The duration of analgesia needed was significantly shorter in the laparoscopic group (1.2 days vs. 2.7 days).
- The laparoscopic group required more morphine in the first 24 hours, despite similar NSAID use.
Conclusions:
- Laparoscopic fundoplication offers a benefit in terms of decreased duration of pain.
- The primary advantage lies in the reduced period for which analgesia is required post-surgery.
Abstract:
To introduce a new procedure, careful evaluation of its effects must be undertaken to assess its impact. Laparoscopic procedures in children are a relatively new phenomenon. A reduction in analgesia is a frequently quoted benefit of a laparoscopic procedure. The introduction of laparoscopic fundoplication into our surgical armoury lead us to evaluate the analgesia requirements of a laparoscopic procedure compared to conventional surgery. Comparative analysis of the analgesia requirements of 40 fundoplication procedures (20 laparoscopic, 20 open) was undertaken. All the pain-relief data was prospectively documented by a pain team as part of an ongoing hospital audit. This pain team was unaware of the comparative study, but were assessing the quality of analgesia within the hospital trust. The total amount of morphine analgesia required was similar for both laparoscopic and open surgery (0.432+/-0.28, 0.427+/-0.28 mg/kg). The period for which analgesia was required was significantly less in the laparoscopic group (1.2+/-0.46, 2.7+/-0.67 days; p = 0.03), yet the requirement for morphine during the first 24 hours was greater in the laparoscopic group (0.399+/-0.19, 0.22+0.11 mg/kg, p = 0.02) despite similar NSAID requirements (18+/-17.28, 18+/-20.16 mg/kg, respectively). The benefit of a laparoscopic over an open fundoplication would appear to be in the decreased duration of pain, as indicated by the decreased duration of analgesia following surgery.