Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T14:03:57.082Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

Published online by Cambridge University Press:  16 November 2022

Dana B. Gal Open the ORCID record for Dana B. Gal [Opens in a new window] ,
Caitlin O. Clyde ,
Erin L. Colvin ,
Jessica Colyer ,
Anne M. Ferris ,
Mayte I. Figueroa ,
Brittney K. Hills ,
Sarah M. Lagergren Open the ORCID record for Sarah M. Lagergren [Opens in a new window] ,
Jordan Mangum  and
Jessica L. Mann
...Show all authors
Dana B. Gal*
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Caitlin O. Clyde
Affiliation:
UT Southwestern Medical Center, Heart Center at Children’s Health, Dallas, TX, USA
Erin L. Colvin
Affiliation:
Heart Institute, Division of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
Jessica Colyer
Affiliation:
Heart Center, Seattle Children’s Hospital, Seattle, WA, Division of Pediatrics, University of Washington, Seattle, WA, USA
Anne M. Ferris
Affiliation:
Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
Mayte I. Figueroa
Affiliation:
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO, USA
Brittney K. Hills
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Sarah M. Lagergren
Affiliation:
Heart Center, Children’s Mercy Hospital, Kansas City, MO, USA
Jordan Mangum
Affiliation:
Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
Jessica L. Mann
Affiliation:
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO, USA
Angela S. McKeta
Affiliation:
Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Sonali S. Patel
Affiliation:
Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
Jennifer F. Reeves
Affiliation:
Division of Pediatric Cardiac Surgery, Shawn Jenkins Children’s Hospital at Medical University of South Carolina, Charleston, SC, USA
Molly Richter
Affiliation:
Heart Center, Seattle Children’s Hospital, Seattle, WA, USA
Lisa M. Ring
Affiliation:
Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
Joshua M. Rosenblum
Affiliation:
Division of Cardiac Surgery, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
Kaitlin Tindel
Affiliation:
UT Southwestern Medical Center, Heart Center at Children’s Health, Dallas, TX, USA
Jeffrey G. Weiner
Affiliation:
Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
Kimberly G. Williams
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA
Luis M. Zabala
Affiliation:
UT Southwestern Medical Center, Heart Center at Children’s Health, Dallas, TX, USA
Nicolas L. Madsen
Affiliation:
UT Southwestern Medical Center, Heart Center at Children’s Health, Dallas, TX, USA
*
Author for correspondence: Dana B. Gal, 3333 Burnett Ave., Cincinnati, OH 45229, USA. Tel: +1 513 803 4574; Fax: +1 513 803 4493. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline.

Methods:

A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus

Results:

60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations.

Conclusions:

Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.

Keywords

Clinical practice guidelinepostoperative painCHD
Type
Guidelines
Information
Cardiology in the Young , Volume 32 , Issue 12 , December 2022 , pp. 1881 - 1893
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schwaller, F, Fitzgerald, M. The consequences of pain in early life: injury-induced plasticity in developing pain pathways. Eur J Neurosci 2014; 39: 344–352.10.1111/ejn.12414CrossRefGoogle ScholarPubMed
Pollak, U, Serraf, A. Pediatric cardiac surgery and pain management: after 40 years in the desert, have we reached the promised land? World J Pediatr Congenit Heart Surg 2018; 9: 315–325.CrossRefGoogle ScholarPubMed
Fuller, S, Kumar, SR, Roy, N, et al. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162: 931–954.CrossRefGoogle Scholar
Roy, N, Parra, MF, Brown, ML, et al. Initial experience introducing an enhanced recovery program in congenital cardiac surgery. J Thorac Cardiovasc Surg 2020; 160: 1313–1321.CrossRefGoogle ScholarPubMed
Pollak, U, Bronicki, RA, Achuff, BJ, Checchia, PA. Postoperative pain management in pediatric patients undergoing cardiac surgery: where are we heading? J Intensive Care Med 2019, 885066619871432.Google ScholarPubMed
Diaz, LK. Anesthesia and postoperative analgesia in pediatric patients undergoing cardiac surgery. Pediatr Drugs 2006; 8: 223–233.10.2165/00148581-200608040-00002CrossRefGoogle ScholarPubMed
Hehir, DA, Easley, RB, Byrnes, J. Noncardiac challenges in the cardiac ICU: feeding, growth and gastrointestinal complications, anticoagulation, and analgesia. World J Pediatr Congenit Heart Surg 2016; 7: 199–209.CrossRefGoogle ScholarPubMed
Thompson, EJ, Foote, HP, King, CE, et al. A systematic review of the evidence supporting post-operative medication use in congenital heart disease. Cardiol Young 2021; 31: 707–733.CrossRefGoogle ScholarPubMed
Wolf, AR, Jackman, L. Analgesia and sedation after pediatric cardiac surgery. Paediatr Anaesth 2011; 21: 567–576.CrossRefGoogle ScholarPubMed
Zeilmaker-Roest, GA, Wildschut, ED, Van Dijk, M, et al. An international survey of management of pain and sedation after paediatric cardiac surgery. BMJ Paediatr Open 2017; 1: 1.CrossRefGoogle ScholarPubMed
Graham, R, Mancher, M, Miller Wolman, D, Greenfield, S, Steinberg, E (eds). Clinical Practice Guidelines We Can Trust. Washington (DC), 2011.CrossRefGoogle Scholar
Rotter, T, Kinsman, L, James, E, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 2010 CD006632.Google ScholarPubMed
Plishka, CT, Rotter, T, Penz, ED, et al. Effects of clinical pathways for COPD on patient, professional, and systems outcomes: a systematic review. Chest 2019; 156: 864–877.CrossRefGoogle ScholarPubMed
Neame, MT, Chacko, J, Surace, AE, Sinha, IP, Hawcutt, DB. A systematic review of the effects of implementing clinical pathways supported by health information technologies. J Am Med Inform Assoc 2019; 26: 356–363.CrossRefGoogle ScholarPubMed
Guyatt, GH, Oxman, AD, Kunz, R, et al. Going from evidence to recommendations. BMJ 2008; 336: 1049–1051.CrossRefGoogle ScholarPubMed
Guyatt, GH, Oxman, AD, Kunz, R, et al. What is "quality of evidence" and why is it important to clinicians? BMJ 2008; 336: 995–998.CrossRefGoogle Scholar
Guyatt, GH, Oxman, AD, Vist, GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924–926.CrossRefGoogle ScholarPubMed
Hasson, F, Keeney, S, McKenna, H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32: 1008–1015.Google ScholarPubMed
Thompson, EJ, Foote, HP, King, CE, et al. A systematic review of the evidence supporting post-operative medication use in congenital heart disease. Cardiol Young 2021; 31: 707–733.CrossRefGoogle ScholarPubMed
Bignami, E, Castella, A, Pota, V, et al. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol 2018; 84: 488–503.CrossRefGoogle ScholarPubMed
Bastero, P, DiNardo, JA, Pratap, JN, Schwartz, JM, Sivarajan, VB. Early perioperative management after pediatric cardiac surgery: review at PCICS 2014. World J Pediatr Congenit Heart Surg 2015; 6: 565–574.CrossRefGoogle ScholarPubMed
Van Valen, R, Van Vuuren, H, Van Domburg, RT, Van Der Woerd, D, Hofland, J, Bogers, AJJC. Pain management after cardiac surgery: experience with a nurse-driven pain protocol. Eur J Cardiovasc Nur 2012; 11: 62–69.CrossRefGoogle ScholarPubMed
Lincoln, PA, Whelan, K, Hartwell, LP, et al. Nurse-implemented goal-directed strategy to improve pain and sedation management in a pediatric cardiac ICU. Pediatr Crit Care Med 2020; 21: 1064–1070.CrossRefGoogle Scholar
Magner, C, Valkenburg, AJ, Doherty, D, et al. The impact of introducing nurse-led analgesia and sedation guidelines in ventilated infants following cardiac surgery. Intens Crit Care Nur 2020; 60: 102879.CrossRefGoogle ScholarPubMed
Franck, LS, Ridout, D, Howard, R, Peters, J, Honour, JW. A comparison of pain measures in newborn infants after cardiac surgery. Pain 2011; 152: 1758–1765.CrossRefGoogle ScholarPubMed
Cury, MR, Martinez, FE, Carlotti, AP. Pain assessment in neonates and infants in the post-operative period following cardiac surgery. Postgrad Med J 2013; 89: 63–67.CrossRefGoogle ScholarPubMed
Bai, J, Hsu, L, Tang, Y, Van Dijk, M. Validation of the COMFORT Behavior Scale and the FLACC Scale for pain assessment in Chinese children after cardiac surgery. Pain Manag Nurs 2012; 13: 18–26.CrossRefGoogle ScholarPubMed
Bai, J, Hsu, L. Pain status and sedation level in Chinese children after cardiac surgery: an observational study. J Clin Nurs 2013; 22: 137–147.CrossRefGoogle ScholarPubMed
Huth, MM, Broome, ME, Mussatto, KA, Morgan, SW. A study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery. Pain Manag Nurs 2003; 4: 31–39.CrossRefGoogle ScholarPubMed
Sabin, JA, Greenwald, AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health 2012; 102: 988–995.CrossRefGoogle ScholarPubMed
Strand, NH, Mariano, ER, Goree, JH, et al. Racism in pain medicine: we can and should do more. Mayo Clin Proc 2021; 96: 1394–1400.CrossRefGoogle Scholar
Fanta, M, Ladzekpo, D, Unaka, N. Racism and pediatric health outcomes. Curr Probl Pediatr Adolesc Health Care 2021; 51: 101087.CrossRefGoogle ScholarPubMed
Karuppiah, N, Pehora, C, Haller, C, Taylor, K. Surgical closure of atrial septal defects in young children - a review of anesthesia care in sternotomy and thoracotomy approaches. J Cardiothorac Vasc Anesth 2021; 35: 123–127.CrossRefGoogle ScholarPubMed
Harvey, KA, Kovalesky, A. Post-operative pain and comfort in children after heart surgery: a comparison of nurses and families pre-operative expectations. J Pediatr Nurs 2018; 43: 9–15.CrossRefGoogle ScholarPubMed
Kumar, A, Das, S, Chauhan, S, Kiran, U, Satapathy, S. Perioperative anxiety and stress in children undergoing congenital cardiac surgery and their parents: effect of brief intervention—a randomized control trial. J Cardiothor Vasc Anesth 2019; 33: 1244–1250.CrossRefGoogle ScholarPubMed
Iguidbashian, JP, Chang, PH, Iguidbashian, J, Lines, J, Maxwell, BG. Enhanced recovery and early extubation after pediatric cardiac surgery using single-dose intravenous methadone. Ann Card Anaesth 2020; 23: 70–74.Google ScholarPubMed
Barnett, AM, Machovec, KA, Ames, WA, et al. The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements. Paediatr Anaesth 2020; 30: 773–779.CrossRefGoogle ScholarPubMed
Robinson, JD, Caruso, TJ, Wu, M, Kleiman, ZI, Kwiatkowski, DM. Intraoperative methadone is associated with decreased perioperative opioid use without adverse events: a case-matched cohort study. J Cardiothor Vasc Anesth 2020; 34: 335–341.CrossRefGoogle ScholarPubMed
Abdelbaser, II, Mageed, NA. Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study. J Clin Anesth 2020; 67: 110002.CrossRefGoogle ScholarPubMed
Zhang, Y, Chen, S, Gong, H, Zhan, B. Efficacy of bilateral transversus thoracis muscle plane block in pediatric patients undergoing open cardiac surgery. J Cardiothor Vasc Anesth 2020; 34: 2430–2434.CrossRefGoogle ScholarPubMed
Cakmak, M, Isik, O. Transversus thoracic muscle plane block for analgesia after pediatric cardiac surgery. J Cardiothor Vasc Anesth 2021; 35: 130–136.CrossRefGoogle ScholarPubMed
Türköz, A, Balcı, ST, Can Güner, M, et al. Anesthesia management with single injection paravertebral block for aorta coarctation in infant. Paediatr Anaesth 2013; 23: 1078–1083.CrossRefGoogle ScholarPubMed
Sahajanandan, R, Varsha, AV, Kumar, DS, et al. Efficacy of paravertebral block in "Fast-tracking" pediatric cardiac surgery - experiences from a tertiary care center. Ann Card Anaesth 2021; 24: 24–29.Google ScholarPubMed
Otu, C, Vo, V, Staffa, SJ, et al. The use of regional catheters in children undergoing repair of aortic coarctation. J Cardiothorac Vasc Anesth 2021; 35: 3694–3699.CrossRefGoogle ScholarPubMed
Macaire, P, Ho, N, Nguyen, T, et al. Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery - a patient-matched, controlled before-and-after study. J Cardiothorac Vasc Anesth 2019; 33: 1659–1667.CrossRefGoogle ScholarPubMed
Roy, N, Brown, ML, Parra, MF, et al. Bilateral erector spinae blocks decrease perioperative opioid use after pediatric cardiac surgery. J Cardiothor Vasc Anesth 2021; 35: 2082–2087.CrossRefGoogle ScholarPubMed
Caruso, TJ, Lin, C, O'Connell, C, et al. Systemic absorption of lidocaine from continuous erector spinae plane catheters after congenital cardiac surgery: a retrospective study. J Cardiothorac Vasc Anesth 2020; 34: 2986–2993.CrossRefGoogle ScholarPubMed
Kaushal, B, Chauhan, S, Magoon, R, et al. Efficacy of bilateral erector spinae plane block in management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. J Cardiothor Vasc Anesth 2020; 34: 981–986.CrossRefGoogle ScholarPubMed
Chaudhary, V, Chauhan, S, Choudhury, M, Kiran, U, Vasdev, S, Talwar, S. Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study. J Cardiothor Vasc Anesth 2012; 26: 439–442.CrossRefGoogle ScholarPubMed
Moga, FX, Lo Galbo, MD, Overman, DM, Friedrichsdorf, SJ. Post-cardiotomy parasternal nerve block with bupivacaine may be associated with reduced post-operative opioid use in children: a retrospective cohort study. Children (Basel) 2020; 7: 7.Google ScholarPubMed
Kaushal, B, Chauhan, S, Saini, K, et al. Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves II block, and intercostal nerve block for the management of postoperative thoracotomy pain after pediatric cardiac surgery. J Cardiothor Vasc Anesth 2019; 33: 418–425.CrossRefGoogle ScholarPubMed
Samantaray, DJ, Trehan, M, Chowdhry, V, Reedy, S. Comparison of hemodynamic response and postoperative pain score between general anaesthesia with intravenous analgesia versus general anesthesia with caudal analgesia in pediatric patients undergoing open-heart surgery. Ann Cardiac Anaesth 2018; 22: 35–40.CrossRefGoogle Scholar
Nguyen, KN, Byrd, HS, Tan, JM. Caudal analgesia and cardiothoracic surgery: a look at postoperative pain scores in a pediatric population. Paediatr Anaesth 2016; 26: 1060–1063.CrossRefGoogle Scholar
Nasr, DA, Abdelhamid, HM. The efficacy of caudal dexmedetomidine on stress response and postoperative pain in pediatric cardiac surgery. Ann Cardiac Anaesth 2013; 16: 109–114.CrossRefGoogle ScholarPubMed
Evans, MA, Monahan, A, Abhold, E, Hajduk, J, Vu, E, Suresh, S. The utilization of caudal hydromorphone for fast-tracking in congenital cardiac surgery in a tertiary-care children’s hospital: an audit. J Clin Anesth 2021; 72: 72.CrossRefGoogle Scholar
Maharramova, M, Taylor, K. A systematic review of caudal anesthesia and postoperative outcomes in pediatric cardiac surgery patients. Semin Cardiothorac Vasc Anesth 2019; 23: 237–247.CrossRefGoogle ScholarPubMed
Hammer, GB, Ramamoorthy, C, Cao, H, et al. Postoperative analgesia after spinal blockade in infants and children undergoing cardiac surgery. Anesth Analg 2005; 100: 1283–1288.CrossRefGoogle ScholarPubMed
Tirotta, CF, Munro, HM, Salvaggio, J, et al. Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery. Paediatr Anaesth 2009; 19: 571–576.CrossRefGoogle ScholarPubMed
Paladini, G, Di Carlo, S, Musella, G, et al. Continuous wound infiltration of local anesthetics in postoperative pain management: safety, efficacy and current perspectives. J Pain Res 2020; 13: 285–294.CrossRefGoogle ScholarPubMed
Elkomy, MH, Drover, DR, Galinkin, JL, Hammer, GB, Glotzbach, KL. Pharmacodynamic analysis of morphine time-to-remedication events in infants and young children after congenital heart surgery. Clin Pharmacokinet 2016; 55: 1217–1226.CrossRefGoogle ScholarPubMed
Murray-Torres, TM, Tobias, JD, Winch, PD. Perioperative opioid consumption is not reduced in cyanotic patients presenting for the Fontan procedure. Pediatr Cardiol 2021; 42: 1170–1179.CrossRefGoogle Scholar
Mota, FA, Marcolan, JF, Pereira, MH, Milanez, AM, Dallan, LA, Diccini, S. Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery. Rev Bras Cir Cardiovasc 2010; 25: 38–44.CrossRefGoogle ScholarPubMed
Epstein, HM. Postoperative patient- controlled analgesia in the pediatric cardiac intensive care unit. Crit Care Nurse 2017; 37: 55–61.CrossRefGoogle ScholarPubMed
Goot, BH, Kaufman, J, Pan, Z, et al. Morphine pharmacokinetics in children with down syndrome following cardiac surgery. Pediatr Crit Care Med 2018; 19: 459–467.CrossRefGoogle ScholarPubMed
Valkenburg, AJ, Calvier, EA, van Dijk, M, et al. Pharmacodynamics and pharmacokinetics of morphine after cardiac surgery in children with and without Down syndrome. Pediatr Crit Care Med 2016; 17: 930–938.CrossRefGoogle ScholarPubMed
Vogel, ER, Staffa, SJ, DiNardo, JA, Brown, ML. Dosing of opioid medications during and after pediatric cardiac surgery for children with Down syndrome. J Cardiothorac Vasc Anesth 2022; 36: 195–199.CrossRefGoogle ScholarPubMed
Van Driest, SL, Shah, A, Marshall, MD, et al. Opioid use after cardiac surgery in children with Down syndrome. Pediatr Crit Care Med 2013; 14: 862–868.CrossRefGoogle ScholarPubMed
Elkomy, MH, Drover, DR, Glotzbach, KL, et al. Pharmacokinetics of morphine and its metabolites in infants and young children after congenital heart surgery. AAPS J 2016; 18: 124–133.CrossRefGoogle ScholarPubMed
Chou, R, Gordon, DB, de Leon-Casasola, OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016; 17: 131–157.CrossRefGoogle Scholar
Dagan, O, Klein, J, Bohn, D, Barker, G, Koren, G. Morphine pharmacokinetics in children following cardiac surgery: effects of disease and inotropic support. J Cardiothorac Vasc Anesth 1993; 7: 396–398.CrossRefGoogle ScholarPubMed
Frankel, WC, Maul, TM, Chrysostomou, C, et al. A minimal opioid postoperative management protocol in congenital cardiac surgery: safe and effective. Semin Thorac Cardiovasc Surg 2020.Google ScholarPubMed
Penk, JS, Lefaiver, CA, Brady, CM, Steffensen, CM, Wittmayer, K. Intermittent versus continuous and intermittent medications for pain and sedation after pediatric cardiothoracic surgery; a randomized controlled trial. Crit Care Med 2018; 46: 123–129.CrossRefGoogle ScholarPubMed
Savva, DA, Kishk, OA, Morgan, JA, Biggs, JM, Seung, H, Bauer, C. Post-operative non-steroidal anti-inflammatory drug use for pain in infant and paediatric cardiac surgery patients. Cardiol Young 2019; 29: 1440–1444.CrossRefGoogle ScholarPubMed
Saini, A, Maher, KO, Deshpande, SR. Nonopioid analgesics for perioperative and cardiac surgery pain in children: current evidence and knowledge gaps. Ann Pediatr Cardiol 2020; 13: 46–55.Google ScholarPubMed
Moffett, BS, Wann, TI, Carberry, KE, Mott, AR. Safety of ketorolac in neonates and infants after cardiac surgery. Paediatr Anaesth 2006; 16: 424–428.CrossRefGoogle ScholarPubMed
Dawkins, TN, Barclay, CA, Gardiner, RL, Krawczeski, CD. Safety of intravenous use of ketorolac in infants following cardiothoracic surgery. Cardiol Young 2009; 19: 105–108.CrossRefGoogle ScholarPubMed
Gupta, A, Daggett, C, Drant, S, Rivero, N, Lewis, A. Prospective randomized trial of ketorolac after congenital heart surgery. J Cardiothor Vasc Anesth 2004; 18: 454–457.CrossRefGoogle ScholarPubMed
Jalkut, MK. Ketorolac as an analgesic agent for infants and children after cardiac surgery: safety profile and appropriate patient selection. AACN Adv Crit Care 2014; 25: 23–30.CrossRefGoogle ScholarPubMed
Gupta, A, Daggett, C, Ludwick, J, Wells, W, Lewis, A. Ketorolac after congenital heart surgery: does it increase the risk of significant bleeding complications? Paediatr Anaesth 2005; 15: 139–142.CrossRefGoogle ScholarPubMed
Inoue, M, Caldarone, CA, Frndova, H, et al. Safety and efficacy of ketorolac in children after cardiac surgery. Intens Care Med 2009; 35: 1584–1592.CrossRefGoogle ScholarPubMed
Acharya, M, Dunning, J. Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure? Interact Cardiov Thorac Surg 2010; 11: 461–467.CrossRefGoogle ScholarPubMed
Jelacic, S, Bollag, L, Bowdle, A, Rivat, C, Cain, KC, Richebe, P. Intravenous acetaminophen as an adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse effects: a randomized controlled trial. J Cardiothor Vasc Aneth 2016; 30: 997–1004.CrossRefGoogle Scholar
Mallama, M, Valencia, A, Rijs, K, Rietdijk, WJR, Klimek, M, Calvache, JA. A systematic review and trial sequential analysis of intravenous vs. oral peri-operative paracetamol. Anaesthesia 2021; 76: 270–276.CrossRefGoogle ScholarPubMed
Ahlers, SJ, Van Gulik, L, Van Dongen, EP, Bruins, P, Tibboel, D, Knibbe, CA. Aminotransferase levels in relation to short-term use of acetaminophen four grams daily in postoperative cardiothoracic patients in the intensive care unit. Anaesth Intensive Care 2011; 39: 1056–1063.CrossRefGoogle ScholarPubMed
Cattabriga, I, Pacini, D, Lamazza, G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. Eur J Cardiothorac Surg 2007; 32: 527–531.CrossRefGoogle ScholarPubMed
Mian, P, Valkenburg, AJ, Allegaert, K, et al. Population pharmacokinetic modeling of acetaminophen and metabolites in children after cardiac surgery with cardiopulmonary bypass. J Clin Pharmacol 2019; 59: 847–855.CrossRefGoogle ScholarPubMed
Donnellan, A, Sawyer, J, Peach, A, Staveski, S, Nelson, DP, Pratap, JN. Reducing exposure to opioid and benzodiazepine medications for pediatric cardiac intensive care patients: a quality improvement project. Pediatr Crit Care Med 2019; 20: 340–349.CrossRefGoogle ScholarPubMed
Kim, JS, Kaufman, J, Patel, SS, Manco-Johnson, M, Di Paola, J, da Cruz, EM. Antiplatelet effect of ketorolac in children after congenital cardiac surgery. World J Pediatr Congenit Heart Surg 2018; 9: 651–658.CrossRefGoogle ScholarPubMed
Aranda, JV, Salomone, F, Valencia, GB, Beharry, KD. Non-steroidal anti-inflammatory drugs in newborns and infants. Pediatr Clin North Am 2017; 64: 1327–1340.CrossRefGoogle ScholarPubMed
Ziesenitz, VC, Zutter, A, Erb, TO, van den Anker, JN. Efficacy and safety of ibuprofen in infants aged between 3 and 6 months. Paediatr Drugs 2017; 19: 277–290.CrossRefGoogle ScholarPubMed
Green, C, Krafft, H, Guyatt, G, Martin, D. Symptomatic fever management in children: a systematic review of national and international guidelines. PLoS One 2021; 16: e0245815.CrossRefGoogle ScholarPubMed
Uber, AM, Montez-Rath, ME, Kwiatkowski, DM, Krawczeski, CD, Sutherland, SM. Nephrotoxin exposure and acute kidney injury in critically ill children undergoing congenital cardiac surgery. Pediatr Nephrol 2018; 33: 2193–2199.CrossRefGoogle ScholarPubMed
Miller, TA, Lisanti, AJ, Witte, MK, et al. A collaborative learning assessment of developmental care practices for infants in the cardiac intensive care unit. J Pediatr 2020; 220: 93–100.CrossRefGoogle ScholarPubMed
Van Der Heijden, MJE, Araghi, SO, Van Dijk, M, Jeekel, J, Hunink, MGM. The effects of perioperative music interventions in pediatric surgery: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 2015; 10: e0133608.CrossRefGoogle ScholarPubMed
Huang, YL, Lei, YQ, Liu, JF, Cao, H, Yu, XR, Chen, Q. The music video therapy in postoperative analgesia in preschool children after cardiothoracic surgery. J Cardiac Surg 2021; 36: 2308–2313.CrossRefGoogle ScholarPubMed
Huang, YL, Lei, YQ, Liu, JF, Cao, H, Yu, XR, Chen, Q. Comparison of the effectiveness of music video therapy and music therapy on pain after cardiothoracic surgery in preschool children. Heart Surg Forum 2021; 24: E299–E304.CrossRefGoogle ScholarPubMed
Kakar, E, Billar, RJ, van Rosmalen, J, Klimek, M, Takkenberg, JJM, Jeekel, J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart 2021; 8: e001474.CrossRefGoogle ScholarPubMed
Staveski, SL, Boulanger, K, Erman, L, et al. The impact of massage and reading on children’s pain and anxiety after cardiovascular surgery: a pilot study. Pediatr Crit Care Med 2018; 19: 725–732.CrossRefGoogle ScholarPubMed
Harrison, TM, Brown, R, Duffey, T, et al. Effects of massage on postoperative pain in infants with complex congenital heart disease. Nurs Res 2020; 69: S36–S46.CrossRefGoogle ScholarPubMed
Albert, NM, Gillinov, AM, Lytle, BW, Feng, J, Cwynar, R, Blackstone, EH. A randomized trial of massage therapy after heart surgery. Heart Lung: J Acute Crit Care 2009; 38: 480–490.CrossRefGoogle ScholarPubMed
Araujo, AS, Klamt, JG, Vicente, WV, Garcia, LV. Pain and cardiorespiratory responses of children during physiotherapy after heart surgery. Rev Bras Cir Cardiovasc 2014; 29: 163–166.Google ScholarPubMed
Chen, LL, Lei, YQ, Liu, JF, Cao, H, Yu, XR, Chen, Q. Application and effects of an early childhood education machine on analgesia and sedation in children after cardiothoracic surgery. J Cardiothorac Surg 2021; 16.CrossRefGoogle ScholarPubMed
Mayan, M, Alvadj, T, Punja, S, Jou, H, Wildgen, S, Vohra, S. Parents' experiences of an inpatient pediatric integrative medicine service for symptom management. Explore (NY) 2019; 15: 415–418.CrossRefGoogle ScholarPubMed
Lisanti, AJ, Demianczyk, AC, Costarino, A, et al. Skin-to-skin care is a safe and effective comfort measure for infants before and after neonatal cardiac surgery. Pediatr Crit Care Med 2020; 21: E834–E841.CrossRefGoogle ScholarPubMed
Lander, J, Fowler-Kerry, S. TENS for children’s procedural pain. Pain 1993; 52: 209–216.CrossRefGoogle ScholarPubMed
Irfan, A, Martin, LY, Canner, J, et al. The impact of post-operative opioid guidelines on prescribing behaviors in the pediatric population. Pediatr Surg Int 2020; 36: 1339–1343.CrossRefGoogle ScholarPubMed
Monitto, CL, Hsu, A, Gao, S, et al. Opioid prescribing for the treatment of acute pain in children on hospital discharge. Anesth Analg 2017; 125: 2113–2122.CrossRefGoogle ScholarPubMed
Holst, KA, Dearani, JA, Schaff, HV, et al. What drives opioid prescriptions after cardiac surgery: practice or patient? Ann Thorac Surg 2020; 110: 1201–1208.CrossRefGoogle ScholarPubMed
Supplementary material: File

Gal et al. supplementary material

Table S1

Download Gal et al. supplementary material(File)
File 17.9 KB