Efficacy of regional analgesia in prevention of chronic postsurgical pain in children on the PEDSQL General Well-Being Scale and Pediatric Pain Questionnaire
DOI:
https://doi.org/10.15574/PS.2023.79.7Keywords:
Chronic Pain, Quality of Life, Children, Regional Analgesia, РreventionAbstract
Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health.
Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires.
Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block.
Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia.
Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p<0.001) on the scales of General Well-Being, General Health, Present Pain, and Worst Pain. This shows the need for using effective minimally invasive regional analgesia techniques in the perioperative period.
Conclusions. Chronic pain syndrome reduces quality of life in children by reducing their general well-being and general health due to high indicators of present and worst pain. Regional analgesia techniques are a priority for the prevention of chronic pain syndrome.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the author.
References
Baidya DK, Maitra S, Arora MK, Agarwal A. (2015). Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth. 27 (8): 694-696. https://doi.org/10.1016/j.jclinane.2015.05.006; PMid:26174113
Batoz H, Semjen F, Bordes-Demolis M, Bénard A, Nouette-Gaulain K. (2016). Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study. Br J Anaesth. 117 (4): 489-496. https://doi.org/10.1093/bja/aew260; PMid:28077537
Blanco R, Ansari T, Girgis E. (2015). Quadratus lumborum block for post-operative pain after caesarean section: a randomised controlled trial. Eur J Anaesthesiol. 32 (11): 812-818. https://doi.org/10.1097/EJA.0000000000000299; PMid:26225500
Blanco R, Ansari T, Riad W, Shetty N. (2016). Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 41 (6): 757-762. https://doi.org/10.1097/AAP.0000000000000495; PMid:27755488
Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. (2017). The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Analg. 125 (1): 303-312. https://doi.org/10.1213/ANE.0000000000001922; PMid:28277325
Dmytriiev D, Dmytriiev K, Stoliarchuk O, Semenenko A. (2019). Multiple organ dysfunction syndrome: What do we know about pain management? A narrative review. Anaesth Intensive Care. 23 (1): 84-91.
Dmytriiev D. (2018). Assessment and treatment of postoperative pain in children. Anaesth Intensive Care. 22 (3): 392-400.
Elsharkawy H, Ahuja S, DeGrande S, Maheshwari K, Chan V. (2019). Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures. J Anesth. 33 (1): 148-154. https://doi.org/10.1007/s00540-018-02605-1; PMid:30659364
Hassett AL, Hilliard PE, Goesling J, Clauw DJ, Harte SE, Brummett CM. (2013). Reports of chronic pain in childhood and adolescence among patients at a tertiary care pain clinic. J Pain. 14: 1390-1397. https://doi.org/10.1016/j.jpain.2013.06.010; PMid:24021576
Hebbard Р. (2009). Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Can J Anesth. 56 (8): 618-620. https://doi.org/10.1007/s12630-009-9110-1; PMid:19495909
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. (2010). The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 11: 1230-1239. https://doi.org/10.1016/j.jpain.2010.07.002; PMid:20797916
Jöhr M. (2015). Regional anaesthesia in neonates, infants and children: an educational review. Eur J Anaesthesiol. 32: 289-297. https://doi.org/10.1097/EJA.0000000000000239; PMid:25693139
Kristensen AD, Ahlburg P, Lauridsen MC, Jensen TS, Nikolajsen L. (2012). Chronic pain after inguinal hernia repair in children. Br J Anaesth. 109 (4): 603-608. https://doi.org/10.1093/bja/aes250; PMid:22831892
Matza LS, Swensen AR, Flood EM, Secnik K, Leidy NK. (2004). Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health. 7 (1): 79-92. https://doi.org/10.1111/j.1524-4733.2004.71273.x; PMid:14720133
Merella F, Canchi-Murali N, Mossetti V. (2019). General principles of regional anesthesia in children. BJA Educ. 19 (10): 342-348. https://doi.org/10.1016/j.bjae.2019.06.003; PMid:33456856 PMCid:PMC7807952
Mossetti V, Boretsky K, Astuto M, Locatelli BG, Zurakowski D, Lio R et al. (2018). Persistent pain following common outpatient surgeries in children: a multicenter study in Italy. Paediatr Anaesth. 28 (3): 231-236. https://doi.org/10.1111/pan.13321; PMid:29352738
Rosenbloom BN, Pagé MG, Isaac L, Campbell F, Stinson JN, Wright JG et al. (2019). Pediatric chronic postsurgical pain and functional disability: a prospective study of risk factors up to one year after major surgery. J Pain Res. 12: 3079-3098. https://doi.org/10.2147/JPR.S210594; PMid:31814752 PMCid:PMC6858804
Schug SA, Lavand'homme P, Barke A, Korwisi B, Rief W, Treede R et al. (2019). The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 160 (1): 45-52. https://doi.org/10.1097/j.pain.0000000000001413; PMid:30586070
Thompson RJ, Gustafson KE. (1996). Adaptation to chronic childhood illness. American Psychological Association. https://doi.org/10.1037/10188-000
Ueshima H, Otake H, Lin JA. (2017). Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2752876. https://doi.org/10.1155/2017/2752876; PMid:28154824 PMCid:PMC5244003
Uzark K, Jones K, Burwinkle TM, Varni JW. (2003). The Pediatric Quality of Life Inventory™ in children with heart disease. Prog Pediatr Cardiol. 18: 141-148. https://doi.org/10.1016/S1058-9813(03)00087-0
Varni JW, Burwinkle TM, Dickinson P, Sherman SA, Dixon P, Ervice JA et al. (2004). Evaluation of the built environment at a children's convalescent hospital: development of the Pediatric Quality of Life Inventory parent and staff satisfaction measures for pediatric health care facilities. J Dev Behav Pediatr. 25 (1): 10-20. https://doi.org/10.1097/00004703-200402000-00002; PMid:14767351
Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL. (2003). The PedsQL in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and type 1 Diabetes Module. Diabetes Care. 26 (3): 631-637. https://doi.org/10.2337/diacare.26.3.631; PMid:12610013
Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P. (2002). The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module. Cancer. 94 (7): 2090-2106. https://doi.org/10.1002/cncr.10428; PMid:11932914
Varni JW, Burwinkle TM, Rapoff MA, Kamps JL, Olson N. (2004). The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and Asthma Module. J Behav Med. 27 (3): 297-318. https://doi.org/10.1023/B:JOBM.0000028500.53608.2c; PMid:15259457
Varni JW, Burwinkle TM, Seid M, Skarr D. (2003). The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 3 (6): 329-341. https://doi.org/10.1367/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2; PMid:14616041
Varni JW, Burwinkle TM, Szer IS. (2004). The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability and validity. J Rheumatol. 31 (12): 2494-2500.
Varni JW, Katz ER, Colegrove R, Dolgin M. (1996). Family functioning predictors of adjustment of children with newly diagnosed cancer: a prospective analysis. J Child Psychol Psychiat. 37 (3): 321-328. https://doi.org/10.1111/j.1469-7610.1996.tb01409.x; PMid:8707915
Varni JW, Quiggins DJL, Ayala GX. (2000). Development of the Pediatric Hematology/Oncology Parent Satisfaction survey. Child Health Care. 29 (4): 243-255. https://doi.org/10.1207/S15326888CHC2904_2
Varni JW, Seid M, Knight TS, Burwinkle TM, Brown J, Szer IS. (2002). The PedsQL in pediatric rheumatology: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory Generic Core Scales and Rheumatology Module. Arthritis Rheum. 46 (3): 714-725. https://doi.org/10.1002/art.10095; PMid:11920407
Varni JW, Seid M, Knight TS, Uzark K, Szer IS. (2002). The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. J Behav Med. 25 (2): 175-193. https://doi.org/10.1023/A:1014836921812; PMid:11977437
Varni JW, Seid M, Kurtin PS. (1999). Pediatric health-related quality of life measurement technology: a guide for health care decision makers. JCOM. 6: 33-44.
Varni JW, Seid M, Kurtin PS. (2001). PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 39 (8): 800-812. https://doi.org/10.1097/00005650-200108000-00006; PMid:11468499
Varni JW, Seid M, Rode CA. (1999). The PedsQL™: measurement model for the Pediatric Quality of Life Inventory. Med Care. 37 (2): 126-139. https://doi.org/10.1097/00005650-199902000-00003; PMid:10024117
Varni JW, Wallander JL. (1988). Pediatric chronic disabilities. In: Handbook of Pediatric Psychology. Edited by Routh DK: 190-221.
Williams G, Howard RF, Liossi C. (2017). Persistent postsurgical pain in children and young people: prediction, prevention, and management. Pain Rep. 2 (5): e616. https://doi.org/10.1097/PR9.0000000000000616; PMid:29392231 PMCid:PMC5777679
Woolf CJ. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain. 152: 2-15. https://doi.org/10.1016/j.pain.2010.09.030; PMid:20961685 PMCid:PMC3268359
Woolf CJ. (2020). Capturing novel non-opioid pain targets. Biol Psychiatry. 87 (1): 74-81. https://doi.org/10.1016/j.biopsych.2019.06.017; PMid:31399256 PMCid:PMC6898770
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