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Background: Chemotherapy‐induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy‐induced severe oral mucositis in children and conducted a large single‐center case series. Methods: Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis. Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient‐ or nurse‐controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment‐related pain. Results: Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3–22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0‐97 mcg/kg/h). Our 7‐year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12–17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co‐analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8–22.2] days vs opioid alone 6.0 [3.9–10.8] days; median [IQR]); but not with age or sex. Conclusions: Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment‐related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services. [ABSTRACT FROM AUTHOR]

Background: The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta‐analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children. Methods: We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed‐ or random‐effects model, depending on whether the heterogeneity tested by the I2 statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method. Results: Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0 h (standardized mean difference [SMD]: −1.07; 95% confidence interval [CI]: −1.60 to −0.54; I2 = 52%), 6 h (SMD: −0.82; 95% CI: −1.39 to −0.25; I2 = 79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I2 = 16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block. Conclusions: This review provides low‐quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large‐sized and well‐designed randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

All peripheral regional anesthetics performed at BCH from January 1, 2019, to April 30, 2021, were tallied and sorted by type of block: single injection, inpatient nerve catheter, or CPNB home catheter. Single-injection blocks are shown in red, inpatient continuous peripheral nerve block (CPNB) catheters in blue, and CPNB home catheters in green. Future studies will focus on analysis of the Regional Anesthesia Database for outcome data related to pediatric home catheters, including opioid-use reduction in patients discharged with home CPNBs. [Extracted from the article]

We looked at 10 consecutive patients having bilateral lower extremity surgery with a single surgeon and compared each patient with a control patient matched by GMFCS, age, diagnosis, and procedure. Keywords: acute pain; limb surgery; orthopedics; outcomes; regional EN acute pain limb surgery orthopedics outcomes regional 582 583 2 03/30/22 20220401 NES 220401 DATA AVAILABILITY STATEMENT Data available on request from the authors. [Extracted from the article]

In order to reduce postoperative opioid requirement, extrapleural local anaesthetic infusion dosing recommendations and guidelines for extrapleural catheter insertion were developed in our institution for 'extubatable' neonates requiring short-gap neonatal tracheo-oesophageal fistula/oesophageal atresia repair (via thoracotomy) and audited prospectively. Data audited included patient characteristics, analgesia details and ventilation duration. We divided patients into two groups: group 1 - term patients (=36 weeks gestational age) with birth-weights =2.5 kg; group 2 - pre-term patients (<36 weeks gestational age), with birth weights <2.5 kg and those with co-morbidities. There were 26 neonates in group 1 and 11 in group 2. All received extrapleural infusions of bupivacaine or levobupivacaine: the majority (90%) =300 µg.kg(-1).hour(-1) (median duration 43 hours, range 1.5 to 72 hours); 36% required morphine infusion and 39% were ventilated (median duration 34 hours, range 3 to 140 hours). In group 1, 24% required morphine infusion compared with 64% in group 2. Most group 1 patients (77%) were extubated immediately postoperatively; 20% had short duration ventilation (median 15 hours, range 11 to 37 hours); one required longer-term ventilation (231 hours). 82% of group 2 were ventilated for a median of 72 hours (range 3 to 140 hours). Review of patients' co-morbidities facilitated guideline revision. These now specify use in neonates requiring short-gap tracheo-oesophageal fistula/oesophageal atresia repair who are term at =36 weeks gestational age and =2.5 kg birth-weight, anticipated as ready for extubation either immediately or shortly after surgery. [ABSTRACT FROM AUTHOR]

Background. Chronic pain following trauma may be mediated in part by the sympathetic nervous system. There is evidence of sympathetic nervous system dysfunction in patients who suffer from posttraumatic headaches. Not all patients will obtain relief from conventional and antineuropathic medications. Furthermore, the development of adverse effects may limit therapeutic dosing or continuation of these medications. Case Report. A pediatric case of posttraumatic headache is described. The patient failed medical therapy, and a single stellate ganglion blockade was performed for possible sympathetic involvement. Following sympathetic blockade, the patient's headaches resolved completely. The analgesia proved to be long lasting as the patient reported no further headaches at monthly follow-up intervals. The patient did not require any further analgesic medication after the single procedure. Conclusion. Posttraumatic headache is difficult to treat. Although there is evidence of sympathetic nervous system dysfunction in some patients, the extent to which this influences pain remains to be determined. While most cases are treated with a combination of nonpharmacological and pharmacological measures, sympathetic blockade via the stellate ganglion may be an alternative for those patients not responding to conventional therapy. [ABSTRACT FROM AUTHOR]