title: Scheduled oral analgesics and the need for opiates in children following partial dorsal rhizotomy.
abstract: OBJECTIVE
  Postoperative epidural morphine is commonly used to control pain in children following dorsal rhizotomy for spasticity. The authors report their experience in using a regimen of scheduled minor analgesic drugs to manage postoperative pain, with the goal of avoiding opiate use following a spinal intradural procedure.
  
  
  METHODS
  Postoperative pain scores were analyzed in a group of 22 children who underwent a partial dorsal rhizotomy. According to a preestablished standard regimen for postoperative pain control after dorsal rhizotomy, in each patient an intraoperative epidural catheter was placed for the potential infusion of postoperative morphine. Additionally, this cohort underwent a scheduled regimen of acetaminophen (10 mg/kg) and ibuprofen (10 mg/kg), alternating every 2 hours. For comparison, a retrospective chart review was performed in 20 patients with rhizotomies completed prior to the use of this oral analgesic protocol. Only one patient received a postoperative dose of morphine epidurally. None of the remaining patients required postoperative epidural morphine for pain control. Pain scores were significantly lower in this group compared with a retrospective review of patients treated according to the standard regimen. Length of hospital stay was shorter in these patients and antiemetic requirements were lower.
  
  
  CONCLUSIONS
  A regimen of minor analgesic therapy, when given in alternating doses every 2 hours immediately after partial dorsal rhizotomy for spasticity and throughout hospitalization, significantly reduced postoperative pain scores, hospitalization, and antiemetic requirements in these patients.
authors.affiliation: Section of Pediatric Neurosurgery, Department of Pediatrics, University of Alabama at Birmingham and Children's Hospital, Birmingham, Alabama 35233, USA. rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Charles
authors.initials: C
authors.lastname: Law
authors.forename: Drew
authors.initials: D
authors.lastname: Davis
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: Leslie
authors.initials: L
authors.lastname: Acakpo-Satchivi
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000284:Administration, Oral; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine; D007052:Ibuprofen