Evaluating the role for regional analgesia in children with spina bifida: a retrospective observational study comparing the efficacy of regional versus systemic analgesia protocols following major urological surgery.

Autor:	Moore RP; Department of Anesthesiology, Division of Pediatric Anesthesiology, Stony Brook Children's Hospital, Stony Brook, New York, USA robert.moore5@stonybrookmedicine.edu., Burjek NE; Division of Pediatric Anesthesiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Brockel MA; Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA.; Department of Anesthesiology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA., Strine AC; Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Acks A; Department of Surgery, Division of Urology, Washington University in St Louis, St. Louis, Missouri, USA., Boxley PJ; Department of Surgery, Division of Urology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA., Chidambaran V; Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Vricella GJ; Department of Surgery, Division of Urology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.; Department of Pediatric Urology, St Louis Children's Hospital, St Louis, Missouri, USA., Chu DI; Division of Urology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Sankaran-Raval M; Division of Pediatric Anesthesiology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA., Zee RS; Division of Urology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA., Cladis FP; Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA., Chaudhry R; Division of Pediatric Urology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA., O'Reilly-Shah VN; Department of Pediatric Anesthesiology, University of Washington, Seattle, Washington, USA.; Deperatment of Pedaitric Anesthesiology, Seattle Children's Hospital, Seattle, Washington, USA., Ahn JJ; Department of Urology, University of Washington, Seattle, Washington, USA.; Department of Urology, Seattle Children's Hospital, Seattle, Washington, USA., Rove KO; Department of Surgery, Division of Urology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.; Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2023 Jan; Vol. 48 (1), pp. 29-36. Date of Electronic Publication: 2022 Sep 27.
DOI:	10.1136/rapm-2022-103823
Abstrakt:	Introduction: Regional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery. Methods: A retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight. Results: 158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34-51) for no regional to 64 min (IQR 40-97) for regional catheters (p<0.01). The regional catheter group had lower median intraoperative opioid usage (0.24 vs 0.80 mg/kg morphine equivalents, p<0.01) as well as lower in-hospital postoperative opioid usage (0.05 vs 0.23 mg/kg/day morphine equivalents, p<0.01). Pain scores were not higher in the regional catheters group. Discussion: Continuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population. Trial Registration Number: NCT03245242. Competing Interests: Competing interests: KOR is a site investigator for AbbVie. (© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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