Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría
Barra lateral del artículo
Publicado:
dic 31, 2022
Palabras clave:
Cirugía de columna, pediatría, dolor posoperatorio, analgesia multimodal
Contenido principal del artículo
Resumen
Introducción: La cirugía de columna es uno de los procedimientos con mayor morbimortalidad dentro de la población pediátrica; el manejo farmacológico del dolor en dicha población aún no se encuentra estandarizado. La analgesia multimodal trata de responder a esta problemática.
Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolomultimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños.
Materiales y Métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA.
Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna.
Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales.Nivel de Evidencia: II
Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolomultimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños.
Materiales y Métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA.
Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna.
Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales.Nivel de Evidencia: II
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Piantoni, L., Tello, C. A., Remondino, R. G., Galaretto, E., & Noel, M. A. (2022). Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(6), 825-837. https://doi.org/10.15417/issn.1852-7434.2022.87.6.1490
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Derechos de autor 2022 Revista de la Asociación Argentina de Ortopedia y Traumatología
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Por la presente, acepta/n las modificaciones que sean necesarias, sugeridas en la revisión por los pares (referato), para adaptar el trabajo al estilo y modalidad de publicación de la Revista.
Citas
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4. Piantoni L, Tello CA, Francheri Wilson IA, Remondino R, Galaretto E, et al. Manejo del dolor posoperatorio
por cirugía de columna en la población pediátrica. Resultados preliminares. Rev Asoc Argent Ortop Traumatol
2019;84(3):224-35. https//doi.org/10.15417/issn.1852-7434.2019.84.3.9314
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https://doi.org/10.1093/pm/pnaa002
17. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin
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postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med 2014;15(6):e247-52.
https://doi.org/10.1097/PCC.0000000000000119
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https://doi.org/10.1097/EJA.0000000000000366
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multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech 2010;23(2):139-45.
https://doi.org/10.1097/BSD.0b013e3181cf07ee
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results in decreased length of stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: A description of implementation strategies and retrospective before-and-after study of outcomes. J Clin Anesth 2021;75:110493. https://doi.org/10.1016/j.jclinane.2021.110493
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32. https://doi.org/10.1097/CORR.0000000000000597
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2. Walker CT, Gullotti DM, Prendergast V, Radosevich J, Grimm D, Cole TS, et al. Implementation of standardized
multimodal postoperative analgesia protocol improves pain control, reduces opioid consumption, and shortens
length of hospital stay after posterior lumbar spinal fusion. Neurosurgery 2020;87(1):130-6. https://doi.org/10.1093/neuros/nyz312
3. Cozowicz C, Bekeris J, Poeran J, Zubizarreta N, Schwenk E, Girardi F, et al. Multimodal pain management and
postoperative outcomes in lumbar spine fusion surgery: A population-based cohort study. Spine (Phila Pa 1976)
2020;45(9):580-9. https://doi.org/10.1097/BRS.0000000000003320
4. Piantoni L, Tello CA, Francheri Wilson IA, Remondino R, Galaretto E, et al. Manejo del dolor posoperatorio
por cirugía de columna en la población pediátrica. Resultados preliminares. Rev Asoc Argent Ortop Traumatol
2019;84(3):224-35. https//doi.org/10.15417/issn.1852-7434.2019.84.3.9314
5. Yousefifard M, Askarian-Amiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A. Pre-hospital pain
management; a systematic review of proposed guidelines. Arch Acad Emerg Med 2019;7(1):e55. PMID: 31875209
6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF, et al. Clinical practice guidelines for the
management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791-
803. https://doi.org/10.1007/s00586-018-5673-2
7. Hsu JR, Mir H, Wally MK, Seymour RB. Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical practice guidelines for pain management in acute musculoskeletal injury. J Orthop Trauma 2019;33(5):e158-e182. https://doi.org/10.1097/BOT.0000000000001430
8. Aubrun F, Nouette-Gaulain K, Fletcher D, Belbachir A, Beloeil H, Carles M, et al. Revision of expert panel’s
guidelines on postoperative pain management. Anaesth Crit Care Pain Med 2019;38(4):405-11. https://doi.org/10.1016/j.accpm.2019.02.011
9. Shah SA, Guidry R, Kumar A, White T, King A, Heffernan MJ. Current trends in pediatric spine deformity surgery: multimodal pain management and rapid recovery. Global Spine J 2020;10(3):346-52. https://doi.org/10.1177/2192568219858308
10. Sheffer BW, Kelly DM, Rhodes LN, Sawyer JR. Perioperative pain management in pediatric spine surgery. Orthop Clin North Am 2017;48(4):481-6. https://doi.org/10.1016/j.ocl.2017.06.004
11. Johnson MA, Andras LM, Andras LE, Ellington MD, Upasani VV, Shah AS. What’s new in pain management for
pediatric orthopaedic surgery. J Pediatr Orthop 2021;41(10):e923-3928. https://doi.org/10.1097/BPO.0000000000001956
12. Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol
2008;21(3):313-6. https://doi.org/10.1097/ACO.0b013e3282f82baa
13. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116:248–273.
https://doi.org/10.1097/ALN.0b013e31823c1030
14. Aoki Y, Iwata H, Akinaga C, Shiko Y, Kawasaki Y, Kobayashi K, et al. Intraoperative remifentanil dosage in surgery for adolescent idiopathic scoliosis does not increase postoperative opioid consumption when combined with epidural analgesia: A retrospective cohort study. Cureus 2021;13(8):e17361. https://doi.org/10.7759/cureus.17361
15. Bean BA, Connor PM, Schiffern SC, Hamid N. Outpatient shoulder arthroplasty at an ambulatory surgery center using a multimodal pain management approach J Am Acad Orthop Surg Glob Res Rev 2018;2:e064.
https://doi.org/10.5435/JAAOSGlobal-D-18-00064
16. Creary SE, Chisolm DJ, Wrona SK, Cooper JN. Opioid prescription filling trends among children with sickle cell
disease after the release of state-issued guidelines on pain management. Pain Med 2020;21(10):2583-92.
https://doi.org/10.1093/pm/pnaa002
17. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin
Anaesthesiol 2019;33(3):259-67. https://doi.org/10.1016/j.bpa.2019.07.016
18. Joshi GP, Kehlet H; PROSPECT Working Group. Guidelines for perioperative pain management: need for reevaluation. Br J Anaesth 2017;119(4):703-6. https://doi.org/10.1093/bja/aex304
19. Jones JS, Cotugno RE, Singhal NR, Soares N, Semenova J, Nebar S, et al. Evaluation of dexmedetomidine and
postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med 2014;15(6):e247-52.
https://doi.org/10.1097/PCC.0000000000000119
20. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol 2016;33(3):160-71.
https://doi.org/10.1097/EJA.0000000000000366
21. Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med 2020;29(3):365-74. https://doi.org/10.17219/acem/112600
22. McNicol ED, Rowe E, Cooper TE. Ketorolac for postoperative pain in children. Cochrane Database Syst Rev
2018;7(7):CD012294. https://doi.org/10.1002/14651858.CD012294.pub2
23. Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. J Spine
Surg 2019;5(2):S154-9. https://doi.org/10.21037/jss.2019.05.04
24. Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, et al. Comparison of perioperative oral
multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech 2010;23(2):139-45.
https://doi.org/10.1097/BSD.0b013e3181cf07ee
25. Rao KE, Krodel D, Toaz EE, Fanelli J, Hajduk J, Kato K, et al. Introduction of an enhanced recovery pathway
results in decreased length of stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: A description of implementation strategies and retrospective before-and-after study of outcomes. J Clin Anesth 2021;75:110493. https://doi.org/10.1016/j.jclinane.2021.110493
26. YaDeau JT, Dines DM, Liu SS, Gordon MA, Goytizolo EA, Lin Y, et al. What pain levels do TSA patients
experience when given a long-acting nerve block and multimodal analgesia? Clin Orthop Relat Res 2019;477:622-
32. https://doi.org/10.1097/CORR.0000000000000597
27. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect 2012;61:389-95. PMID: 22301247
28. Li WT, Bell KL, Yayac M, Barmann JA, Star AM, Austin MS. A postdischarge multimodal pain management
cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: A grouprandomized trial. J Arthroplasty 2021;(36) 164e172. https://doi.org/10.1016/j.arth.2020.07.060
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