Enhanced Recovery After Surgery (ERAS) consensus recommendations for opioid-minimising pharmacological neonatal pain management.

Autor:	Pilkington M; Department of Surgery, Division of Pediatric General and Thoracic Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Canada mpilkington@ariadnelabs.org.; Ariadne Labs, Boston, Massachusetts, USA., Pentz B; University of Calgary, Calgary, Canada., Short K; The University of British Columbia Faculty of Medicine, Vancouver, Canada., Marchand T; University of Calgary Cumming School of Medicine, Calgary, Canada., Aziz S; University of Calgary, Calgary, Canada., Lam JY; Department of Surgery, Western University Schulich School of Medicine & Dentistry, London, Canada., Spencer A; Department of Anesthesia and Pain Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada., Brockel MA; Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA., Else S; Department of Anesthesia and Pain Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada., McLuckie D; Department of Anesthesia, Victoria General Hospital, Victoria, Canada., Franklin A; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., de Beer D; Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK., Raval MV; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Scott M; Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Department of Anaesthesia and Critical Care Medicine, University College London, London, UK., Brindle ME; Department of Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada.; Ariadne Labs, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ paediatrics open [BMJ Paediatr Open] 2024 Oct 08; Vol. 8 (1). Date of Electronic Publication: 2024 Oct 08.
DOI:	10.1136/bmjpo-2024-002824
Abstrakt:	Objective: Enhanced recovery after surgery (ERAS) guidelines have been successfully applied to children and neonates. There is a need to provide evidence-based consensus recommendations to manage neonatal pain perioperatively to ensure adequate analgesia while minimising harmful side effects. Methods: Following a stakeholder needs assessment, an international guideline development committee (GDC) was established. A modified Delphi consensus iteratively defined the scope of patient and procedure inclusion, topic selection and recommendation content regarding the pharmacologic management of neonatal pain. Critical appraisal tools assessed the relevance and quality of full-text studies. Each recommendation underwent a formal Grades of Recommendation, Assessment, Development and Evaluation (GRADE) assessment of the quality of evidence and expert consensus was used to determine the strength of recommendations. Results: The GDC included paediatric anaesthesiologists, surgeons, and ERAS methodology experts. The population was defined as neonates at >32 weeks gestational age within 30 days of life undergoing surgery or painful procedures associated with surgery. Topic selection targeted pharmacologic opioid-minimising strategies. A total of 4249 abstracts were screened for non-opioid analgesia and 738 abstracts for the use of locoregional analgesia. Full-text review of 18 and 9 articles, respectively, resulted in two final recommendations with a moderate quality of evidence to use regular acetaminophen and to consider the use of locoregional analgesia. There was inadequate evidence to guide the use of other non-opioid adjuncts in this population. Conclusions: Evidence-based, ERAS-driven consensus recommendations were developed to minimise opioid usage in neonates. Further research is required in this population to optimize multimodal strategies for pain control. Competing Interests: Competing interests: All authors were asked to declare any competing interests. There were no disclosed competing interests that influenced the guideline process or development of recommendations. Mary E Brindle is on the Executive of the ERAS Society. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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