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Epidural and opioid analgesia following the Nuss procedure.

Walaszczyk M, Knapik P, Misiolek H, Korlacki W - Med. Sci. Monit. (2011)

Bottom Line: Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects.Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group.Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain.

View Article: PubMed Central - PubMed

Affiliation: University Department of Anesthesiology and Intensive Therapy, Medical University of Silesia, Zabrze, Poland.

ABSTRACT

Background: Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. material/methods: The study subjects were 61 adolescents aged 11-18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents' consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted "butterfly" cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects.

Results: Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group.

Conclusions: Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.

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Related in: MedlinePlus

Percentage of sedation scores over 2, according to the Ramsay scale on the first postoperative day.
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f3-medscimonit-17-11-ph81: Percentage of sedation scores over 2, according to the Ramsay scale on the first postoperative day.

Mentions: In the opioid group, metamizol and morphine were used routinely, as part of the study protocol. The mean daily dose of metamizol and morphine, calculated for the entire postoperative period, was 12 mg/kg and 0.16 mg/kg, respectively. In 6 patients (30%), the standard dose of morphine was exceeded and in 2 patients (10%) there was a temporary need to administer midazolam and ketamine infusions on the second postoperative day. Sedation scores exceeding 2 in the Ramsay scale were more frequent in the opioid group (Figure 3).


Epidural and opioid analgesia following the Nuss procedure.

Walaszczyk M, Knapik P, Misiolek H, Korlacki W - Med. Sci. Monit. (2011)

Percentage of sedation scores over 2, according to the Ramsay scale on the first postoperative day.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539505&req=5

f3-medscimonit-17-11-ph81: Percentage of sedation scores over 2, according to the Ramsay scale on the first postoperative day.
Mentions: In the opioid group, metamizol and morphine were used routinely, as part of the study protocol. The mean daily dose of metamizol and morphine, calculated for the entire postoperative period, was 12 mg/kg and 0.16 mg/kg, respectively. In 6 patients (30%), the standard dose of morphine was exceeded and in 2 patients (10%) there was a temporary need to administer midazolam and ketamine infusions on the second postoperative day. Sedation scores exceeding 2 in the Ramsay scale were more frequent in the opioid group (Figure 3).

Bottom Line: Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects.Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group.Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain.

View Article: PubMed Central - PubMed

Affiliation: University Department of Anesthesiology and Intensive Therapy, Medical University of Silesia, Zabrze, Poland.

ABSTRACT

Background: Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. material/methods: The study subjects were 61 adolescents aged 11-18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents' consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted "butterfly" cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects.

Results: Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group.

Conclusions: Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.

Show MeSH
Related in: MedlinePlus