title: Pain management for children following selective dorsal rhizotomy.
abstract: Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used for treating lower extremity spasticity in patients with cerebral palsy. The purpose of this paper is to present a review of our institution's first three years' experience with postoperative pain and spasticity management in patients who have undergone SDR. The medical records of the 55 patients who had an SDR during the study period were reviewed. The basis of postoperative analgesia was morphine, with the majority of patients receiving continuous morphine infusions (20-40 micrograms.kg-1.hr-1 (n = 49), 60 micrograms.kg-1.hr-1 (n = 1)). Four patients used a patient-controlled delivery system. One patient had successful analgesia with epidural morphine. Ketorolac (1 mg.kg-1 i.v. loading dose followed by 0.5 mg.kg-1 i.v. every six hr for 48 hr) was used as an adjunct to morphine in six patients. For management of postoperative muscle spasm, an intravenous benzodiazepine was used (diazepam 0.1 mg.kg-1 (n = 2), or midazolam infusion 10-30 micrograms.kg-1.hr-1 (n = 51)). All patients were cared for on a ward where nurses were familiar with the use of continuous opioid and benzodiazepine infusions. All patients received continuous cardiorespiratory monitoring as well as frequent nursing assessment. There were no episodes of postoperative apnoea or excessive sedation. We have found the use of continuous infusions of morphine and midazolam, along with adjunct ketorolac, to be effective in treating postoperative pain and muscle spasms following SDR.
authors.affiliation: Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105.
authors.forename: J M
authors.initials: JM
authors.lastname: Geiduschek
authors.forename: C M
authors.initials: CM
authors.lastname: Haberkern
authors.forename: J F
authors.initials: JF
authors.lastname: McLaughlin
authors.forename: L E
authors.initials: LE
authors.lastname: Jacobson
authors.forename: R M
authors.initials: RM
authors.lastname: Hays
authors.forename: T S
authors.initials: TS
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020910:Ketorolac; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009020:Morphine / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000601:surgery*; D009325:Nausea / Q000139:chemically induced; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D013035:Spasm / Q000517:prevention & control; D013126:Spinal Nerve Roots / Q000601:surgery*; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000700:Analgesics; D009020:Morphine; D014046:Tolmetin; D003975:Diazepam; D008874:Midazolam; D002045:Bupivacaine; D020910:Ketorolac