Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery

Autor:	Hossam Debis, Hassan Wahba, Wahba Z Bakhet, Lobna El Fiky
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	medicine.medical_treatment Remifentanil lcsh:RS1-441 lcsh:RD78.3-87.3 lcsh:Pharmacy and materia medica 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Cochlear implant Medicine Pharmacology (medical) Local anesthesia General Pharmacology Toxicology and Pharmaceutics tiva business.industry cochlear implant 030208 emergency & critical care medicine Anesthesiology and Pain Medicine Opioid lcsh:Anesthesiology Anesthesia Hyperalgesia esrt Original Article Tramadol medicine.symptom business Pediatric anesthesia Propofol local anesthesia postoperative pain medicine.drug pediatric anesthesia
Zdroj:	Journal of Anaesthesiology Clinical Pharmacology, Vol 36, Iss 3, Pp 366-370 (2020) Journal of Anaesthesiology, Clinical Pharmacology
ISSN:	0970-9185
Popis:	Background and Aims: Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA. Material and Methods: Prospective, randomized, double-blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, n = 35) or control (CT group, N = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well. Results: The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, P < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2–12] vs. 3 [0–8] h, P < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) μg/kg/min; P = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups. Conclusion: Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.
Databáze:	OpenAIRE
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