ABSTRACT
BACKGROUND: The purpose of this prospective study was to assess the blood-sparing effect, the quality of analgesia, and the incidence of side-effects of a low-dose regime of intrathecal opioids (ITO) when compared with those of a high-dose regime in scoliosis surgery in children. METHODS: Forty-six children were randomly included into one of the three groups to receive morphine 5 microg kg(-1) plus sufentanil 1 microg kg(-1) [low-dose intrathecal opioid (LITO)], morphine 15 microg kg(-1) plus sufentanil 1 microg kg(-1) [high-dose intrathecal opioid (HITO)] intrathecally, or no intrathecal opioid. Postoperative analgesia was provided by i.v. opioids. Intraoperative blood loss, postoperative quality of analgesia, opioid requirements, and the incidence of side-effects were recorded for 3 days. RESULTS: Intraoperative blood loss was significantly reduced by ITOs [LITO: 41.4 (sd 18.8) ml kg(-1); HITO: 37.5 (6.9) ml kg(-1); control: 76.9 (15.3) ml kg(-1), P<0.001], with no difference between the two intrathecal opioid groups. Mean pain scores on the day of surgery were lower in both intrathecal opioid groups (LITO: 2.2 and HITO: 2.1) when compared with the control group (4.1, P<0.03) and opioid consumption was significantly decreased [LITO: 304.3 (65.0) microg kg(-1); HITO: 224.1 (51.8) microg kg(-1); control: 667.7 (89.5) microg kg(-1), P<0.002]. Side-effects of intrathecally administered opioids were similarly frequent in all groups. CONCLUSIONS: Intrathecal administration of opioids significantly reduces blood loss and postoperative opioid demand, thereby showing side-effects comparable with the control group. These effects were already seen with the low-dose regimen and high dose did not further improve efficacy.
Subject(s)
Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/prevention & control , Spinal Fusion , Adolescent , Analgesics, Opioid/adverse effects , Blood Loss, Surgical/prevention & control , Child , Dose-Response Relationship, Drug , Humans , Injections, Spinal , Morphine/adverse effects , Pain Measurement/methods , Postoperative Nausea and Vomiting , Prospective Studies , Pruritus/chemically induced , Single-Blind MethodABSTRACT
Albumin is often cited in textbooks as the gold standard for fluid replacement in paediatrics, but in practice artificial colloids are more frequently used. Although one concern with the use of artificial colloids is their intrinsic action on haemostasis, the available data in children are inconclusive for 6% hydroxyethyl starch 130/0.4 (HES) and no data exist for gelatine solution with respect to coagulation. A total of 42 children (3-15 kg) undergoing surgery and needing colloid replacement were randomly assigned to receive 15 mlxkg(-1) of either albumin 5%, 4% modified gelatine solution or 6% hydroxyethyl starch 130/0.4 solution. Standard coagulation tests and modified thrombelastography (ROTEM) were performed. After colloid administration, routine coagulation test results changed significantly and comparably in all groups, although activated partial thromboplastin time values increased more with gelatine and HES. Coagulation time was unchanged in the children who received albumin or gelatine but other activated modified thrombelastography values were significantly impaired in all groups. After gelatine and after albumin the median clot firmness decreased significantly but remained within the normal range. Following HES, coagulation time increased significantly, and clot formation time, alpha angle, clot firmness, and fibrinogen/fibrin polymerisation were significantly more impaired than for albumin or gelatine, reaching median values below the normal range. From a haemostatic point of view it might be preferable to use gelatine solution as an alternative to albumin; HES showed the greatest effects on the overall coagulation process.
