Θεραπευτική προσέγγιση μετεγχειρητικού πόνου μετά από επέμβαση ανοικτής αποκατάστασης βουβωνοκήλης στα παιδιά (Master thesis)

Παπαδόπουλος, Παναγιώτης

BACΚGR0UND - OBJECTIVES: Open inguinal hernia repair is one of the most common surgical procedures. It is estimated that 35000 hernia repairs take place in Greece annually. Surgical wound pain is a frequent symptom in the postoperative period. Pain, which is a restrictive symptom, negatively influences psychological status and delays return to normal activity and functionality. There exist many different approaches that all address the symptom of postoperative pain. Documentation is available for every method and many clinical trials have been published comparing one method to another. A systematic review of the literature was designed according to ‘The Cochrane Collaboration Handbook”, in order to gather all currently available evidence and proceed to quantitative analysis of the data. MATERIAL - METHODS: A comprehensive search in the bibliographic databases Pubmed, SCOPUS and ISI Web of Knowledge was conducted; 22 randomized controlled studies with a total of 1826 patients were included in the analysis. Reviewed outcomes consisted of postoperative pain scores as measured by different scales specialised for children and secondarily the needs for complementary rescue analgesia during the postoperative period in terms of number of patients requiring further analgesics or/and the amount of analgesics consumed at that period. RESULTS: Due to great heterogeneity between studies included, quantitative analysis is difficult and has many limitations. There is both clinical and methodological heterogeneity among the studies. There are many different techniques for postoperative analgesia and every one can utilize a different analgesic drug or local anaesthetic or combination in various doses. Methodological heterogeneity results from the use of different scales for evaluating pain. Nonetheless, quantitative analysis was meticulously attempted and showed that ilioinguinal/iliohypogastric block may be inferior to other methods (OR=2.96 (1.77-4.95), p<0.0001). In contrast, neither caudal block nor nstillation technique is more effective than the other approaches, since differences were not statistically significant (OR=0.62 (0.32-1.18), p=0.15 and OR=1.83 (0.86-3.89), p=0.12 accordingly). CONCLUSIONS: The question of which is the most effective method for postoperative pain management following an open inguinal hernia repair in children, cannot be answered in a definitive manner. Currently available data from the literature cannot adequately address that question. It seems that caudal block might be superior compared to other methods yet statistically significant differences failed to be revealed. More studies are needed to evaluate different analgesic methods, to make comparisons and produce data that could be systematically reviewed in the future.
Alternative title / Subtitle: μια συστηματική ανασκόπηση
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Πόνος
Keywords: Βουβωνοκήλη,Πόνος,Αναλγησία,Παιδιά,Συστηματική ανασκόπηση,Τυχαιοποιημένες κλινικές μελέτες, Inguinal hernia, Pain,Analgesia,Children,Systematic review,Randomised controlled  trials
URI: https://olympias.lib.uoi.gr/jspui/handle/123456789/29055
http://dx.doi.org/10.26268/heal.uoi.2683
Appears in Collections:Διατριβές Μεταπτυχιακής Έρευνας (Masters)

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