Paraskevi K Matsota*, Eva N Kaminioti and Georgia G Kostopanagiotou
Department of Anaesthesiology, National and Kapodistrian University of Athens, GreeceFulltext PDF
The effect of preemptive and preventive analgesia in children undergoing surgical procedures has not been adequately studied. The aim of this review was to investigate literature regarding the effectiveness of preemptive and preventive analgesia in postoperative pain relief in children undergoing surgery according to the type of both, the surgical procedure and the analgesic intervention, and the analgesic or adjuvant used. Our critical review of prospective randomized controlled trials identified 77 studies; 39 were referred to head and neck surgeries, 31 to urological and lower abdominal procedures, 6 to orthopaedics and one to all the above types of operations. Our literature review demonstrated that the preemptive administration of ketamine (intravenous, topical, caudal) before surgical incision in children undergoing tonsillectomy or urological surgeries probably can enhance postoperative analgesia quality and reduce analgesic demands and it may also be recommended as an alternative safe option to opioids. On the contrary, preventative administration of ketamine in Orthopaedic procedures has not been shown to be beneficial in the management of acute postoperative pain. Dexmedetomidine seems to be a promising adjunct to provide excellent postoperative analgesia especially in urological and lower abdominal operations, given intravenously or caudally, preoperatively. The increasing interest on dexmedetomidine preemptive effects was justified in our review. Literature findings are supporting regarding the use of caudal administration of clonidine and neostigmine. Studies on other kinds of adjuvants in children are very limited and further investigation should be done.
Preemptive; Preventive; Analgesia; Children; Postoperative pain
Matsota PK, Kaminioti EN, Kostopanagiotou GG. Preemptive and Preventive Analgesia in Different Paediatric Surgical Settings: A Systematic Review of Prospective Randomized Controlled Trials. Clin Surg. 2019; 4: 2393.