Good Practice in Postoperative and Procedural Pain Management ...

2.7.6 Laparoscopic surgeryGood practice pointsInfiltration of port sites with LA as part of a multimodalanalgesic strategy may reduce postoperative pain followinglaparoscopy.Although overall postoperative analgesic requirementsappear to be reduced following laparoscopy, pain maybe equivalent to the equivalent open procedure in somecircumstances, particularly during the first 24 h.2.7.7 Orthopaedics, spinal and plastic surgeryGood practice pointThere is no evidence from studies in children thatNSAIDs have a deleterious effect on bone fusion. Theanalgesic benefit of short-term NSAID use has beendemonstrated and may frequently outweigh any hypotheticalrisk.Lower limb surgeryPeripheral nerve blocks provide superior analgesia andare associated with fewer adverse effects compared withintravenous opioids: Grade BContinuous peripheral nerve blocks are feasible, effectiveand safe, and are associated with lower pain scores:Grade BEpidural opioids are effective, reduce the dose requirementsof local anesthetic, and rescue IV opioids butincrease the incidence of side effects: Grade BEpidural techniques are associated with lower painscores than intravenous opioid analgesia: Grade CSystemic paracetamol and NSAID reduce intravenousopioid requirements: Grade CUpper Limb SurgeryBrachial plexus blocks provide satisfactory analgesia forhand and forearm surgery extending into the postoperativeperiod: Grade BThe axillary, infraclavicular, supraclavicular, and interscaleneapproach are feasible and effective: Grade BSpinal surgeryEpidural techniques produce a modest improvement inpain control, compared with intravenous opioids inpatients undergoing corrective surgery for adolescent idiopathicscoliosis: Grade BIntrathecal opioids decrease intra-operative blood lossand IV opioid consumption postoperatively. The durationof action is 18–24 h: Grade CDual catheter epidural techniques should be considered, asthis permits coverage of multiple spinal levels: Grade CThe use of LA + lipophilic opioid in the epidural spacewith a single epidural catheter does not show an analgesicbenefit over intravenous opioid techniques: Grade CThe use of LA + hydrophilic opioids in the epiduralspace has a favorable analgesic profile compared withIV opioid, but at the expense of increased adverseeffects: Grade DCleft lip and palate and related procedures of headand neckInfraorbital nerve block provides effective analgesia forcleft lip repair in the early postoperative period: GradeA2.7.8 Cardiothoracic surgeryCardiac surgery (sternotomy)Epidural and intrathecal techniques with opioid and/orLA are effective for sternotomy pain but only marginalbenefits have been demonstrated, and there is insufficientdata concerning the incidence of serious complications:Grade BThoracotomyEpidural analgesia is effective for post-thoracotomypain: Grade D2.7.9 NeurosurgeryCraniotomy and major neurosurgeryGood practice pointAnalgesia following neurosurgery requires good communicationand close cooperation between members of theperioperative team. Frequent pain assessments should bea routine part of postoperative care. A multimodal analgesicapproach is suitable, which may include the use ofLA infiltration, paracetamol, NSAID (when not contraindicated),and parenteral or oral opioid as determinedby assessed analgesic requirements.ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 9