title: Effectiveness of an anesthetic continuous-infusion device in children with cerebral palsy undergoing orthopaedic surgery.
abstract: BACKGROUND
  Effective postoperative pain management is a vital component of orthopaedic surgical care in the pediatric population. In children with cognitive impairments pain management can be difficult, making these children vulnerable to ineffectively managed postoperative pain. This prospective, randomised study evaluated the use of a local anesthetic continuous infusion device (pain pump) to manage postoperative pain in children with cerebral palsy (CP) undergoing lower extremity orthopaedic surgical procedures.
  
  
  METHODS
  Children with a diagnosis of CP who were undergoing select orthopaedic outpatient procedures were enrolled in this study. Postoperatively, patients were randomised to receive either a pain pump in addition to oral analgesics or oral analgesics only. Patient's parents were asked to record the amount of medication administered and assess pain intensity with the use of a modified visual analogue scale for 3 days postoperatively. Parents also completed an overall pain management satisfaction questionnaire at the end of the study participation period.
  
  
  RESULTS
  Fifty-four patients were enrolled in this study and data were analyzed on 37 patients. The mean daily pain intensity in the pain pump group was significantly lower for the day of surgery and for 2 days postoperatively, and there was an overall significant difference between the groups (P<0.0001). The amount of analgesic medication administered was significantly lower for the first 2 postoperative days, but there was not a significant difference between the 2 groups overall (P=0.29). Parent satisfaction with both pain management techniques was high and responses were similar between the 2 groups.
  
  
  CONCLUSIONS
  Children with CP present unique postoperative pain management concerns that can be effectively addressed through the use of multimodal analgesic techniques. This study found that the pain pump is an effective pain management technique that significantly reduces pain intensity in children with CP after lower extremity orthopaedic procedures.
  
  
  METHODS
  Therapeutic Level II.
authors.affiliation: Orthopaedic Trauma Unit, Aberdeen Royal Infirmary, Aberdeen, UK. Muthusamy.komalam@tchden.org
authors.forename: Komalam
authors.initials: K
authors.lastname: Muthusamy
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Recktenwall
authors.forename: Richard M
authors.initials: RM
authors.lastname: Friesen
authors.forename: Jeannie
authors.initials: J
authors.lastname: Zuk
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Miller
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Galinkin
authors.forename: Franklin M
authors.initials: FM
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D002547:Cerebral Palsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007866:Leg / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D000777:Anesthetics