Epidural Analgesia Versus Intravenous Fentanyl Infusion in Children with Cerebral Palsy Undergo Major Orthopedic Surgery: Randomized Controlled Trial

Authors

  • Prathana W, Nattapong L, Duenpen H, Trisana S, Veerasak T, Ornanong S, Tunchanok P, Tanaporn H

Keywords:

Epidural analgesia, Intravenous fentanyl infusion, Postoperative pain control, Cerebral palsy, Major orthopedic surgery

Abstract

Background : Pelvic varus derotation osteotomy and Dega osteotomy are major orthopedic procedures aim to correct hip subluxation in cerebral palsy patients. These procedures can cause severe postoperative pain which is difficult to manage especially in CP patients who have limited communication ability.

Objective : This study aimed to compare the effectiveness between intravenous fentanyl infusion and epidural analgesia for postoperative pain control.

Methods : A randomized controlled trial was conducted after institutional ethics committee’s approval. 34 patients were enrolled, all received general anesthesia for pelvic varus derotation osteotomy or Dega osteotomy. Then 17 patients were randomized to intravenous fentanyl infusion group (caudal block with intravenous fentanyl infusion) and 17 patients were randomized to epidural analgesia group (epidural block with continuous epidural infusion). The study drugs were continued for 24 hours postoperatively. Postoperative pain were assessed using the Noncommunicative Children’s Pain Checklist Postoperative version. Studied outcomes were: incidence of postoperative pain (NCCPC-PV >10), fentanyl rescue dose, postoperative pain score at PACU, 8, 16, 24 hours and peri-anesthetic complications. Data were analyzed using SPSS version 16.0. Statistics used were Mann–Whitney U-test, Pearson ChiSquare, and Fisher’s Exact Test. P < 0.05 was considered significant.

Results : Baseline characteristics were similar in both groups. The overall incidence of postoperative pain was 67% and the incidence of pain was not statistically different in each group (70.6 % in group IV fentanyl VS. 64.7 % in group epidural, p = 0.71.) Mean postoperative pain scores were not different except for 24 hours postoperatively (4 in IV fentanyl group VS. 1 in epidural group, p = 0.032). The most common complication is postoperative nausea and vomiting (29.4% in IV fentanyl group VS. 35.3% in epidural group, p = 0.714). There were no serious complications in both groups in this study.

Conclusion : Continuous epidural analgesia and intravenous fentanyl infusion for postoperative pain control in children with cerebral palsy undergo major orthopedic surgery resulted in similar pain control in first 24 hours after surgery.

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Published

04-01-2021

How to Cite

1.
Prathana W, Nattapong L, Duenpen H, Trisana S, Veerasak T, Ornanong S, Tunchanok P, Tanaporn H. Epidural Analgesia Versus Intravenous Fentanyl Infusion in Children with Cerebral Palsy Undergo Major Orthopedic Surgery: Randomized Controlled Trial. j dept med ser [Internet]. 2021 Jan. 4 [cited 2022 Oct. 4];45(3):67-75. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/248597

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Original Article