Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA.
Department of Neurological Surgery, University of Miami, 1095 NW 14 Terrace, Miami, FL, 33136, USA.
Childs Nerv Syst. 2024 Dec;40(12):4095-4105. doi: 10.1007/s00381-024-06559-6. Epub 2024 Jul 30.
Surgical selective dorsal rhizotomy (SDR) in appropriate pediatric cerebral palsy patients is an effective treatment for spasticity. However, there remains heterogeneity reported in postoperative pain management with and without opioid medication in this delicate cohort. The objective of this study was to aggregate pertinent metadata by means of systematic review to summarize all relevant postoperative pain regimens in the literature.
Searches of multiple electronic databases from inception to June 2024 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes and regimens were then summarized.
A total of 16 cohort studies were included in this study published between 1989 and 2024. Amongst all studies, outcomes were reported for a total of 636 with median cohort age 6.3 years, and median cohort male proportion 62% was reported. Four studies reported regimens involving systemic analgesia, 8 studies reported regimens involving epidural analgesia, and the remaining 4 studies reported regimens involving intrathecal analgesia. All studies primary pain management involved opioid medication, with 8 studies having opioid medication available as indicated, 3 studies having opioid medication as a single dose, and the remaining studies having opioid medication as a continuous agent in the immediate postoperative period. Across all studies, rates of desaturations, nausea and/or vomiting, and pruritis ranged from 0 to 55%, 25 to 82%, and 15 to 70% respectively. Eleven of the 16 studies included a comparative component, demonstrating that their regimen was at least comparable to their control regimen, if not superior.
Multiple variations of postoperative pain management in pediatric cerebral palsy patients following SDR have been reported in the literature, involving systemic, epidural, and intrathecal analgesia. Concerns for adverse effects with the utilization of opioid medication has led to the trend towards multimodal pain management relying more on non-opioid medication regimens in the more recent literature.
在适当的小儿脑瘫患者中进行外科选择性背根切断术（SDR）是治疗痉挛的有效方法。然而，在这个脆弱的患者群体中，术后疼痛管理中使用和不使用阿片类药物的报道仍然存在异质性。本研究的目的是通过系统评价汇总相关元数据，总结文献中所有相关的术后疼痛方案。
根据 PRISMA 指南，对多个电子数据库进行了从开始到 2024 年 6 月的检索。文章根据预先指定的标准进行筛选。然后总结结果和方案。
本研究共纳入了 1989 年至 2024 年期间发表的 16 项队列研究。在所有研究中，共报道了 636 例患者的结果，中位数队列年龄为 6.3 岁，中位数队列男性比例为 62%。有 4 项研究报告了涉及全身镇痛的方案，8 项研究报告了涉及硬膜外镇痛的方案，其余 4 项研究报告了涉及鞘内镇痛的方案。所有研究的主要疼痛管理均涉及阿片类药物，其中 8 项研究表明阿片类药物可根据需要使用，3 项研究表明阿片类药物为单次剂量，其余研究表明阿片类药物在术后即刻为持续给药。在所有研究中，饱和度下降、恶心和/或呕吐以及瘙痒的发生率分别为 0 至 55%、25 至 82%和 15 至 70%。16 项研究中有 11 项包括了比较部分，表明他们的方案至少与对照组方案相当，如果不是更好的话。
文献中报道了多种小儿脑瘫患者 SDR 术后疼痛管理方案，包括全身、硬膜外和鞘内镇痛。由于对阿片类药物不良反应的担忧，最近的文献中倾向于采用多模式疼痛管理，更多地依赖非阿片类药物方案。
