Effectiveness of multimodal preemptive analgesia in major pediatric abdominal cancer surgery

Abstract

Objective: evaluate efficacy of combining multimodal analgesia and local anesthetic infiltration compared with caudal analgesia among pediatric patients undergoing major abdominal pediatric cancer surgery
Methodology: This randomized controlled pilot study was carried out at postoperative care unit of our institution. This pilot study enrolled 90 children ASA I and II with cancer scheduled for major abdominal surgery through a midline incision. Intervention: patients were randomly divided into three equal groups. The morphine group received IV morphine at a dose of 0.1 mg/kg after induction of anesthesia. The caudal group underwent caudal block. The multimodal group received paracetamol, ketorolac and ketamine infusion, with local wound infiltration of levobupivacaine before skin incision and at the end of surgery. After surgery, all patients were maintained on PCA morphine postoperatively. Primary outcome measure was total postoperative morphine consumption. The secondary endpoints were VAS score for pain, the time to first PCA bolus, and the number of PCA doses.
Results: that there were no between-group differences in the baseline characteristics of the participants. The three analgesic modalities provided adequate pain relief for up to 24 h. The multimodal and caudal groups did not significantly differ in terms of total morphine consumption (p = 0.521), time to first analgesic bolus (p = 0.136), or the number of total and active PCA boluses (p = 0.260 and p = 0.904, respectively). Both groups were superior to the morphine group regarding morphine consumption, time to first analgesic bolus, and the number of total and active PCA boluses
Conclusion: Preemptive multimodal analgesia and caudal block offered comparable efficacy in the target population.
Trial registration: clinicaltrial.gov with no. NCT03580980.
Citation: Ghobrial HZ, Shaker EH. Effectiveness of multimodal preemptive analgesia in major pediatric abdominal cancer surgery. Anaesth pain & intensiv care 2019;23(3):256-262
Received & Reviewed: 16, 21 August 2019. Accepted: 28 August 2019