title: Perioperative analgesia strategies in fast-track pediatric surgery of the kidney and renal pelvis: lessons learned.
abstract: OBJECTIVE
  Effective analgesia is essential for the success of fast-track (FT) pediatric surgery. Aim of the study was to achieve an optimal analgesia protocol for a comfortable postoperative course and early mobilization in children undergoing urological procedures.
  
  
  METHODS
  A prospective study of two analgesia concepts in a series of children undergoing laparoscopic pyeloplasty (LP) and nephrectomy (LN) was performed. Thirty-six consecutive patients received analgesia according to the protocol "Fast Track I" (FT I), 23 patients according to the modified analgesia protocol "Fast Track II" (FT II). Differences between the protocols were frequency of pain measurement, more frequent use of local anesthesia and higher dosage of Acetaminophen. End points were pain intensity, use of opioids and side effects. Data derived from the German reimbursement system (G-DRG) regarding lengths of hospital stay were compared.
  
  
  RESULTS
  On the day of operation (6:00 p.m.), pain scores of patients using FT II were significantly lower than those using the FT I protocol (1.51 + or - 0.4 FT II versus 3.8 + or - 0.4 FT I, p = 0.001). Pain scores still tended to be lower in the FT II group on the first postoperative day (8:00 a.m.), but from that point on, the difference was not significant (1.52 + or - 0.5 FT II versus 2.3 + or - 0.4 FT I, p = 0.186). Hospital stay was short, compared to the German average, in both groups.
  
  
  CONCLUSIONS
  The modified analgesia protocol FT II leads to earlier and more effective pain reduction, lower use of opioids and fewer side effects than the previously used protocol FT I. Hence, modification of analgesia in pediatric urology is essential.
authors: Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. dingemann.jens@mh-hannover.de
authors: Jens
authors: J
authors: Dingemann
authors: Joachim F
authors: JF
authors: Kuebler
authors: Mathias
authors: M
authors: Wolters
authors: Mirja
authors: M
authors: von Kampen
authors: Wilhelm A
authors: WA
authors: Osthaus
authors: Benno M
authors: BM
authors: Ure
authors: Marc
authors: M
authors: Reismann
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000293:Adolescent; D000698:Analgesia / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D019990:Perioperative Care; D011446:Prospective Studies; D014570:Urologic Diseases / Q000601:surgery
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen