The evaluation of the caudal block performance in 0–8-year-old children using FLACC scale

Yıl 2024, Cilt: 49 Sayı: 2, 287 – 295, 30.06.2024

Evrim Burcu Turan Akar , Filiz Üzümcügil , Başak Akça

https://doi.org/10.17826/cumj.1350618

Öz

Amaç: Pediatride ameliyat sonrası ağrının değerlendirilmesi gerçek bir zorluktur. Kaudal blok sonrası FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) ölçeğini kullanarak ameliyat sonrası acil ağrı yönetimini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Ameliyat öncesi genel anestezi altında kaudal blok uygulanan 0-8 yaş arası çocukların anestezi kayıtları değerlendirildi. İntraoperatif ve postoperatif opioid kullanımının yanı sıra FLACC skorları elde edildi.
Bulgular: Yetmiş sekiz çocuk çalışmaya dahil edildi ve 1-24 ay (n=37) ve 24-96 ay (n=41) yaşlarına göre iki grupta değerlendirildi. Hastaların %7.7’sinde (n=6) intraoperatif opioid gereksinimi gözlendi. FLACC ≥4 olan dokuz hastada (%11,5) hemen ameliyat sonrası dönemde fentanil gerekmiştir. Sadece 1 hasta hem intraoperatif hem de hemen postoperatif dönemde opioide ihtiyaç duymuştur ve bu da %98,7’lik bir başarı oranına işaret etmektedir. Hastaların ameliyat sonrası 1., 2. ve 3. saatlerde FLACC ≥4 olmasına rağmen tek doz opioid aldıkları görülmüştür. Yaş alt grupları FLACC skorları ve postoperatif 3 saat içinde bu skorlardaki değişiklikler açısından benzerdi. İdrar retansiyonu veya motor blok görülmedi. Ancak, 24-96 aylık 4 hastada parestezi kaydedilirken, 1-24 aylık hastaların hiçbirinde parestezi kaydedilmedi. Bu farklılığa 1-24 aylıkken tanımlanamayan rahatsız edici uyuşukluk neden olmuş olabileceği gibi, herhangi bir opioid kullanımı olmaksızın yüksek FLACC skorlarına yol açmış olabilir. Sonuç: Çalışmamız anestezistlerin FLACC skalasını tek başına bir gösterge olarak değil, opioid uygulamak için ağrı değerlendirmesinin bir parçası olarak görmelerini desteklemektedir.

Anahtar Kelimeler

Kaudal anestezi, anestezi ve analjezi, ağrı skalası, ağrı değerlendirmesi.

Destekleyen Kurum

Yok

Proje Numarası

Yok

Kaynakça

• Ponde V. Recent trends in paediatric regional anaesthesia. Indian journal of anaesthesia. 2019;63:746-53.
• Suresh S, Long J, Birmingham PK, De Oliveira Jr GS. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesthesia Analgesia. 2015;120:151-6.
• Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain. 2017;18:605-14.
• Frawley G, Ingelmo P. Spinal anaesthesia in the neonate. Best Pract Res Clin Anaesthesiol. 2010;24:337-51.
• Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29:59-66.
• Merkel S, Malviya S. Pediatric pain, tools and assessment. J Perianest Nurs. 2000;15:408-14.
• Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. 2015;156:2132-51.
• Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293-7.
• Merkel S, Voepel-Lewis T, Malviya S. Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN Am J Nurs. 2002;102:55-8.
• Breschan C, Jost R, Krumpholz R, Schaumberger F, Stettner H, Marhofer P et al. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade. Pediatr Anesth. 2005;15:301-6.
• Ivani G, DeNegri P, Conio A, Grossetti R, Vitale P, Vercellino C et al. Comparison of racemic bupivacaine, ropivacaine, and levo-bupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. Reg Anesth Pain Med. 2002;27:157-61.
• Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti A et al. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth. 2005;94:366-71.
• Silvani P, Camporesi A, Agostino M, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol. 2006;72:453-9.
• Wolf AR, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration. J Am Soc Anesthesiol. 1988;69:102-5.
• Gasteiger L, Kirchmair L, Hoerner E, Stundner O, Hollmann MW. Peripheral regional anesthesia using local anesthetics: old wine in new bottles? J Clin Med. 2023;12:1541.
• Chen F, Wang C-Y, Zhang J, Wang F, Zhang M, Gu H et al. Comparison of postoperative analgesic effects between nalbuphine and fentanyl in children undergoing adenotonsillectomy: a prospective, randomized, double-blind, multicenter study. Front Pharmacol. 2020;11:597550.
• Di Sarno L, Gatto A, Korn D, Pansini V, Curatola A, Ferretti S et al. Pain management in pediatric age. An update. Acta Biomed. 2023;94: e2023174.
• Tao B, Liu K, Wang D, Ding M, Yang N, Zhao P. Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized controlled trial. BMC Pediatr. 2019;19:427.
• Coca KK, Maroda AJ, Williams RF, Head TA, Sheyn AM. Perioperative analgesia and pain management in pediatric patients. In Perioperative Pain Control: Tools for Surgeons: A Practical, Evidence-Based Pocket Guide (Eds PF Svider, AA Pashkova, AP Johnson):287-307. Cham, Spirnger, 2021.
• Engelhardt T, Virág K, Veyckemans F, Habre W. Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice in Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe. Br J Anaesth. 2018;121:66-75.
• Wiegele M, Marhofer P, Lönnqvist P-A. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
• Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: Lessons learned from the European Multi‐Institutional Study APRICOT. Pediatr Anesth. 2019;29:1128-35.
• Jöhr M. Regional anaesthesia in neonates, infants and children: an educational review. Eur J Anaesthesiol. 2015;32:289-97.
• Merella F, Canchi-Murali N, Mossetti V. General principles of regional anaesthesia in children. BJA Educ. 2019;19:342.
• Candido KD, Winnie A. Caudal anesthesia. In Textbook of Regional Anesthesia and Acute Pain Management (Ed A Hadzic):269-83. McGraw-Hill, New York. 2007

The evaluation of the caudal block performance in 0–8-year-old children using FLACC scale

Yıl 2024, Cilt: 49 Sayı: 2, 287 – 295, 30.06.2024

Evrim Burcu Turan Akar , Filiz Üzümcügil , Başak Akça

https://doi.org/10.17826/cumj.1350618

Öz

Purpose: The evaluation of postoperative pain in pediatrics is a true challenge. We aimed to evaluate the immediate postoperative pain management using FLACC (Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Scale) scale after caudal block.
Material and Methods: The anesthesia records of children aged 0–8 years who underwent caudal block under general anesthesia prior to surgery were evaluated. The intraoperative and postoperative use of opioids were obtained, as well as, the FLACC scores.
Results: Seventy-eight children were included and evaluated in two groups according to ages of 1-24 (n=37) and 24-96 months (n=41). Intraoperative requirement for opioid was observed in 7.7% (n=6) of patients. Nine patients (11.5%) required fentanyl in the immediate postoperative period with FLACC ≥4. Only 1 patient required opioids both intraoperatively and in the immediate postoperative period, suggesting a success rate of 98.7%. The patients were observed to receive single dose opioid, despite FLACC ≥4 in the following postoperative 1st,2nd and 3rd hours. The subgroups of age were similar in terms of FLACC scores and the changes in these scores within the postoperative 3 hours. There were no urinary retention or motor block. However, paresthesia was recorded in 4 patients at age of 24-96 months, whereas, in none of the patients at age of 1-24 months. The uncomfortable numbness, which could not be described at age of 1-24 months may have caused the difference, as well as, leading to high FLACC scores without any opioid use.
Conclusion: Our study supported that anesthetists consider FLACC scale as a part of pain assessment to administer opioid, not as a sole indicator.

Anahtar Kelimeler

Regional anesthesia, Pediatric Anesthesia, Post-operative pain

Proje Numarası

Yok

Kaynakça

• Ponde V. Recent trends in paediatric regional anaesthesia. Indian journal of anaesthesia. 2019;63:746-53.
• Suresh S, Long J, Birmingham PK, De Oliveira Jr GS. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesthesia Analgesia. 2015;120:151-6.
• Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain. 2017;18:605-14.
• Frawley G, Ingelmo P. Spinal anaesthesia in the neonate. Best Pract Res Clin Anaesthesiol. 2010;24:337-51.
• Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29:59-66.
• Merkel S, Malviya S. Pediatric pain, tools and assessment. J Perianest Nurs. 2000;15:408-14.
• Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. 2015;156:2132-51.
• Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293-7.
• Merkel S, Voepel-Lewis T, Malviya S. Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN Am J Nurs. 2002;102:55-8.
• Breschan C, Jost R, Krumpholz R, Schaumberger F, Stettner H, Marhofer P et al. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade. Pediatr Anesth. 2005;15:301-6.
• Ivani G, DeNegri P, Conio A, Grossetti R, Vitale P, Vercellino C et al. Comparison of racemic bupivacaine, ropivacaine, and levo-bupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. Reg Anesth Pain Med. 2002;27:157-61.
• Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti A et al. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth. 2005;94:366-71.
• Silvani P, Camporesi A, Agostino M, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol. 2006;72:453-9.
• Wolf AR, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration. J Am Soc Anesthesiol. 1988;69:102-5.
• Gasteiger L, Kirchmair L, Hoerner E, Stundner O, Hollmann MW. Peripheral regional anesthesia using local anesthetics: old wine in new bottles? J Clin Med. 2023;12:1541.
• Chen F, Wang C-Y, Zhang J, Wang F, Zhang M, Gu H et al. Comparison of postoperative analgesic effects between nalbuphine and fentanyl in children undergoing adenotonsillectomy: a prospective, randomized, double-blind, multicenter study. Front Pharmacol. 2020;11:597550.
• Di Sarno L, Gatto A, Korn D, Pansini V, Curatola A, Ferretti S et al. Pain management in pediatric age. An update. Acta Biomed. 2023;94: e2023174.
• Tao B, Liu K, Wang D, Ding M, Yang N, Zhao P. Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized controlled trial. BMC Pediatr. 2019;19:427.
• Coca KK, Maroda AJ, Williams RF, Head TA, Sheyn AM. Perioperative analgesia and pain management in pediatric patients. In Perioperative Pain Control: Tools for Surgeons: A Practical, Evidence-Based Pocket Guide (Eds PF Svider, AA Pashkova, AP Johnson):287-307. Cham, Spirnger, 2021.
• Engelhardt T, Virág K, Veyckemans F, Habre W. Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice in Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe. Br J Anaesth. 2018;121:66-75.
• Wiegele M, Marhofer P, Lönnqvist P-A. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
• Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: Lessons learned from the European Multi‐Institutional Study APRICOT. Pediatr Anesth. 2019;29:1128-35.
• Jöhr M. Regional anaesthesia in neonates, infants and children: an educational review. Eur J Anaesthesiol. 2015;32:289-97.
• Merella F, Canchi-Murali N, Mossetti V. General principles of regional anaesthesia in children. BJA Educ. 2019;19:342.
• Candido KD, Winnie A. Caudal anesthesia. In Textbook of Regional Anesthesia and Acute Pain Management (Ed A Hadzic):269-83. McGraw-Hill, New York. 2007

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