Multimodal analgesia with restrictive use of opioid analgesics: assessment of level of Pain Control in Pediatric patients undergoing major abdominal surgeries at CHUK

Abstract

Background: The management of acute postoperative pain is very important as it enhances a smooth recovery for the patient. Most of the time, pediatric patients who undergo major abdominal surgery experience severe pain which requires the use of opioid analgesics to be controlled. The use of multimodal analgesia with restrictive use of opioid analgesics is one of the ways that can be used to achieve this objective.

Objective: This study aimed at assessing the adequacy of pain control when the multimodal analgesia with restrictive use of opioid analgesics is used in pediatric patients undergoing major abdominal surgery at CHUK.

Methods: This was a prospective observational cohort study of 9 months duration from November 2020 to July 2021 assessing the level of pain control when the multimodal analgesia with restrictive use of opioid analgesics is used after major abdominal surgery in pediatric patients at CHUK. The data was collected using a pre-established questionnaire. Data analysis was done using both SPSS, version 16.0. Descriptive statistical analysis, Fisher’s test, bivariate, and multivariate logistic regression analysis were used where applicable.

Results: Ninety patients have been enrolled in the study. 56.7% of patients recruited were males whereas 43.3% of patients recruited were females. Their mean-age was 31.98 months (SD 39.212 months). For all 90 patients who were recruited, the pain control was 100%. The multimodal analgesia was started after surgery with local anesthesia infiltration in 52.2% of the patients whereas in 47.2% of the patients, infiltration with local anesthesia was not done. Opioid analgesics were included in the postoperative multimodal analgesia in 26.6% of the patients and for the rest, that’s 73.3% of patients either received paracetamol and ibuprofen or paracetamol only.

Conclusion: A significant proportion of patients who underwent major abdominal surgery could have their acute postoperative pain controlled with multimodal analgesia that did not include the use of opioid analgesics. Selective addition of opioid analgesics for the patients requiring it allowed to achieve pain control for all the cohort.