PDF(Pubmed)
Abstract：
Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The management of pain throughout the laparoscopic appendectomy (LA) in the pediatric population is a critical concern. This study aimed to evaluate trends in analgesic use and patient satisfaction following LA, with a focus on reducing the reliance on opioids for pain management. From 2003 to 2023, 18258 articles were filtered for all types of analgesic use with LA. The publications were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 19 studies were included for analysis and review. The study included peer-reviewed experimental and observational studies involving individuals under 18 years. Pain management strategies varied across studies, involving a combination of analgesics, nerve blocks, and wound infiltrations. Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids were administered before and after surgery. Some studies implemented patient-controlled analgesia (PCA) pumps. Other studies explored non-pharmacological interventions like magnetic acupuncture. The results showed a reduction in the need for postoperative analgesics in patients treated with LA, particularly when using non-opioid medications and novel analgesic techniques. Pediatric patients who received gabapentin reported lower opioid use, shorter hospital stays, and high satisfaction rates. However, the reliance on opioids remained significant in some cases, particularly among patients with peritonitis who required more morphine. Pain management in pediatric patients is multifaceted, involving preoperative and postoperative analgesics, nerve blocks, and PCA pumps. Efforts to improve pain management following pediatric LA while reducing opioid reliance are essential in the context of the ongoing opioid epidemic. The findings from this study highlight the potential benefits of non-opioid analgesics, nerve blocks, and alternative methods for managing postoperative pain in <18 appendectomy patients. Further research and standardization of pain management protocols are needed to ensure optimal patient outcomes and minimize the risk of opioid-related complications.
摘要：
阿片类药物相关的死亡是美国意外死亡的主要原因。阑尾炎是儿童和青少年腹痛的常见原因。在儿科人群中，整个腹腔镜阑尾切除术（LA）的疼痛管理是一个至关重要的问题。本研究旨在评估LA术后镇痛药使用趋势和患者满意度，重点是减少疼痛管理对阿片类药物的依赖。从2003年到2023年，对18258篇文章进行了过滤，用于与LA一起使用的所有类型的镇痛药。使用系统审查和荟萃分析（PRISMA）指南的首选报告项目筛选出版物。纳入19项研究进行分析和综述.该研究包括同行评审的实验和观察性研究，涉及18岁以下的个人。疼痛管理策略因研究而异，涉及镇痛药的组合，神经阻滞,和伤口浸润。镇痛药，如对乙酰氨基酚，非甾体抗炎药（NSAIDs），和阿片类药物在手术前后给药。一些研究实施了患者自控镇痛（PCA）泵。其他研究探索了非药物干预措施，如磁针。结果显示，接受LA治疗的患者术后镇痛药的需求减少，特别是当使用非阿片类药物和新型镇痛技术时。接受加巴喷丁的儿科患者报告阿片类药物使用率较低，缩短住院时间,满意度高。然而,在某些情况下，对阿片类药物的依赖仍然很大，特别是腹膜炎患者需要更多的吗啡。儿科患者的疼痛管理是多方面的，包括术前和术后镇痛药，神经阻滞,PCA泵。在持续的阿片类药物流行的背景下，努力改善小儿LA后的疼痛管理，同时减少阿片类药物依赖是必不可少的。这项研究的发现强调了非阿片类镇痛药的潜在益处，神经阻滞,以及管理<18例阑尾切除术患者术后疼痛的替代方法。需要对疼痛管理方案进行进一步的研究和标准化，以确保最佳的患者预后并将阿片类药物相关并发症的风险降至最低。
