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. 2023 Sep-Dec;18(3):140-147.
doi: 10.5005/jp-journals-10080-1601.

Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective Case Series of Post-operative Pain and Functional Goals

Alice Wei Ting Wang  1 , Harpreet Chhina  2 , Anthony P Cooper  2
Affiliations

Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective Case Series of Post-operative Pain and Functional Goals

Alice Wei Ting Wang et al. Strategies Trauma Limb Reconstr. 2023 Sep-Dec.

Abstract

Aim: Limb reconstruction with external fixators requires appropriate pain management to promote effective analgesia and healing while minimising adverse events of the analgesic technique used. The objective of this prospective case series was to evaluate a multimodal analgesia regimen designed to reduce opioid requirements and hence reduce the opioid-related side effect profile.

Materials and methods: A prospective cohort of patients undergoing lower limb reconstruction surgery (LRS) were managed through an evidence-informed multimodal analgesia guideline (MMAG), including acetaminophen, pregabalin, dexmedetomidine, IV lidocaine, and opioids. Outcome measures included intraoperative and post-operative opioid administration, post-operative pain scores, time to achieve mobilisation milestones, and post-operative complications. Surveys were conducted to obtain patient reported experiences.

Results: 26 patients were included in this prospective case series. 110.59 (84.29, 162.13) (median, interquartile range) µg/kg/hr intraoperative IV morphine equivalent opioids were administered. In the first 48 hours post-operatively, patients received 11.49 (6.41, 19.35) µg/kg/hr of IV morphine equivalent dose. Median level of pain (0-10) in the first 48 post-operative hours was 2 (1, 2). Patients achieved mobilisation. And 19/20 patients surveyed reported 'yes' to having effective pain management; 17/20 patients had no unwanted side effects associated with analgesia medications. There were no cases of compartment syndrome.

Conclusion: This multimodal analgesia regime applied to patients undergoing lower LRS with external fixators demonstrates the feasibility of this analgesic regimen which revealed effective pain control, early mobilisation, with minimal side effects, but warrants further study.

Clinical significance: This study provides valuable evidence that this standardised multimodal anaesthesia and analgesia regimen is feasible, offers adequate post-operative comfort and encourages early mobilization while minimising opioid use and adverse events in a paediatric LRS population at our institution.

How to cite this article: Wang AWT, Chhina H, Cooper A. Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective Case Series of Post-operative Pain and Functional Goals. Strategies Trauma Limb Reconstr 2023;18(3):140-147.

Keywords: Analgesia; External fixation; Lower limb; Paediatric; Pain; Post-operative.

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Conflict of interest statement

Source of support: The senior author has received an unrestricted research grant from Vilex and an unrestricted research grant from OrthoPediatrics. They are Consultant for OrthoPediatrics. They have been on the advisory board for Cerapedics and have done a consultancy work with IPSEN. The senior author is supported by a salary award from their research institute and research funding from their hospital foundation. Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the details and related images.

Figures

Figs 1A and B
Figs 1A and B
Patient survey responses on pain management. (A) Patient responses to yes/no questions; (B) Patient responses to statements on a 5-point Likert scale. 1, strongly disagree; 2, disagree; 3, neither; 4, agree; 5, strongly agree. n = 20
Fig. 2
Fig. 2
Patient survey responses to yes/no questions with respect to adverse events. n = 20
See this image and copyright information in PMC

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