P69
COMPARISON BETWEEN PAIN MANAGEMENT MODALITIES FOR OPEN PYELOPLASTY IN PAEDIATRICS
L. Assaf, A. Miskovic
Great Ormond Street Hospital, UK
This project delves into the comparative analysis of various approaches to alleviate postoperative pain, shedding light on their efficacy and patient outcomes. The aim is to provide valuable insights that contribute to enhancing the overall surgical experience, postoperative recovery for children undergoing open pyeloplasty and improving the practice tackling pain management in terms of prescribing patient-controlled analgesia/ nurse-controlled analgesia (PCA/NCA).
A retrospective collection of data for 30 patients of different age groups who underwent open pyeloplasty surgery in Great Ormond street Hospital. The patients have been categorized in three groups depending on which pain management modality they had intraoperatively: Quadratus lumborum block (QL), Transversus abdominis plane block (TAP) and local infiltration of local anaesthetics.
26 patients out of 30 have been prescribed NCA/PCA for pain management postoperatively as part of the current practice in GOSH.
We have studied the three pain management modalities in terms of :
- Age and weight.
- Intraoperative pain relief medications : paracetamol, NSAIDS and morphine.
- Pain score for the first and second 12 hours postoperatively and after that.
- NCA/PCA settings, requirement and duration.
- Resumption of oral intake.
- The need for oral morphine post discontinuation of NCA/PCA.
As a result, the median intraoperative morphine doses in Quadratus lumborum block (QL) and Transversus abdominis plane block (TAP) were comparable ( 84 mcg/kg for QL block and 89 mcg/kg for TAP block), while the median dose for the local infiltration group was 104 mcg/kg.
While studying the median number of NCA/PCA pushes for the three modalities in the first twelve hours post-operatively, it was two pushes only.
Furthermore, the median number of pushes after 24 hours of surgery in the three different groups was zero.
Finally, the median pain scores in the first, second twelve hours and after 24 hours of the procedure among the three modalities were very close.
The project concluded that there is no definitive superior technique for pain management in open pyeloplasty among the three studied ones.
Additionally, depending on the outcomes regarding the median number of NCA/PCA pushes and pain scores it's encouraged to change the current practice of prescribing NCA/PCA for open pyeloplasty surgeries and encourage prescribing oral morphine instead taking into consideration resumption of oral intake.
References:
- Zhao WL, Li SD, Wu B, Zhou ZF. Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis. Pain Physician. 2021 Aug;24(5):E555-E563. PMID: 34323442.
- Guo Q, Li R, Wang L, Zhang D, Ma Y. Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: A systematic review and meta-analysis. Int J Clin Exp Med. 2015 Oct 15;8(10):17343-52. PMID: 26770326; PMCID: PMC4694226.
- Lorenzo AJ, Lynch J, Matava C, El-Beheiry H, Hayes J. Ultrasound guided transversus abdominis plane vs surgeon administered intraoperative regional field infiltration with bupivacaine for early postoperative pain control in children undergoing open pyeloplasty. J Urol. 2014 Jul;192(1):207-13. doi: 10.1016/j.juro.2014.01.026. Epub 2014 Feb 8. PMID: 24518763.
- Chisolm PF, Singh NP, Cummins I, Oster RA, Cox D, Dangle PP. Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty. Surgeries. 2021; 2(3):278-285. https://doi.org/10.3390/surgeries2030028