title: Does minimal access major surgery in the newborn hurt less? An evaluation of cumulative opioid doses.
abstract: BACKGROUND
  Minimal access surgery (MAS) in adults is associated with less postoperative pain in comparison to conventional 'open' surgery. It is not known whether this holds true for neonates as well. Less pain would imply that opioid consumption can be reduced, which has a beneficial effect on morbidity.
  
  
  OBJECTIVE
  To evaluate potential differences in' opioid consumption between neonates undergoing thoracoscopic minimal access surgery or conventional surgery of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  In this retrospective cohort study we included two controls for each MAS patient, matched on diagnosis, sex and age at surgery. Opioid dose titration was based on validated pain scores (VAS and COMFORT behaviour), applied by protocol. Cumulative opioid doses at 12, 24, 48 h and 7 days postoperatively were compared between groups with the Mann-Whitney test.
  
  
  RESULTS
  The study group consisted of 24 MAS patients (14 EA; 10 CDH). These were matched to 48 control patients (28 EA; 20 CDH). At none of the time points cumulative opioid (median in mg/kg (IQR)) doses significantly differed between MAS patients and controls, both with CDH and EA. For example at 24 h postoperative for CDH patients cumulative opioid doses were [0.84(0.61-1.83) MAS vs. 1.06(0.60-1.36) p=1.0] controls, For EA patients at 24 h the cumulative opioid doses were [0.48(0.30-0.75) MAS vs. 0.49(0.35-0.79) p=0.83] controls. This held true for the postoperative pain scores as well.
  
  
  CONCLUSIONS
  Minimal access surgery for the repair of esophageal atresia or congenital diaphragmatic hernia is not associated with less cumulative opioid doses.
authors.affiliation: Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Ceelie
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
authors.forename: N M A
authors.initials: NM
authors.lastname: Bax
authors.forename: S N
authors.initials: SN
authors.lastname: de Wildt
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004933:Esophageal Atresia / Q000601:surgery; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects*; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl