Background & Aims
Management of perioperative pain in children is often inadequate especially in settings where resources are limited (1,2). Regional anesthesia is now an integral part of pediatric anesthesia in the developed world because of its well recognized benefits in perioperative pain management (1-3). It is still underutilized in resource-limited settings. The role of RA in pediatric surgery and anesthesia in the developing world is not well documented.
As part of our quality improvement initiatives we evaluated authoritative evidence-based guidelines and recommendations (2,3) and we decided to promote the use of RA in our practice. This study aimed to assess the initial impact of the increased use. We hypothesized that increased use of RA will lead to improved pain management.
Methods
A retrospective cohort chart review of all children aged below 19 yrs who had surgery during a 3-month period was carried out. They were categorized into 2 groups: those who had general anesthesia alone (GA group) and those who had general anesthesia and regional anesthesia (RG group). Routinely we administer RA after the child has been anesthetized. The GA is standard with intravenous or inhalation induction and maintenance, incorporating multimodal analgesia with iv paracetamol, NSAIDs and opioids as necessary. Our RA techniques include neuraxial and peripheral nerve blocks. Our primary endpoint was to compare the early and late postoperative pain scores assessed in the PACU and 24 hr after surgery between the 2 groups. The secondary endpoints were to compare opioid analgesic consumption, time to first rescue analgesic, length of stay in PACU, complications and, caregiver/patient satisfaction. Pain scores were assessed with either FLACC or revised FACES scales.
Results
Results: We reviewed 567 consecutive children of which 125 (22%) had RA. Postoperative pain is managed similarly in all our patients and consists of scheduled paracetamol and ibuprofen (except if contraindicated) and opioids if needed.
Patients who received RA had significantly lower pain scores, both in the PACU (p < 0.005) and 24 hr after surgery (p < 0.01), and they remained pain-free for longer periods than those who had only GA. Patients who received RA required less doses of rescue opioids than those who did not. Only 4% (5/125) of those who received RA required rescue analgesia in PACU compared to 18% (80/442) of those who did not. Patients who received RA had on average a shorter PACU stay than those who did not and they were more alert and required less intensive nursing care. Guardian/patient satisfaction was higher in the RA group (p < 0.05). There were no major analgesia-related complications in either group.
Conclusions
We have shown that RA provides superior and longer lasting pain relief with associated less opioid consumption and better caregivers/patient satisfaction compared to GA alone. RA is safe and effective in resource-poor settings. Further and larger prospective studies are required to validate these findings.
References
1.Anaesthesia 2021;76:74-88
2.The Journal of Pain 2016;17:131-157.
3.JAMA Surg. 2021;156:76-90.
Presenting Author
Andrew Amata
Poster Authors
Andrew Amata
MBBS, FMCA
Beit CURE Hospital, Lusaka, Zambia
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities