Effects of Opioid Sparing Analgesia for Surgical Procedure of Laparoscopic Pyloromyotomy in Order to Enhance Recovery and Better Surgical Outcomes

Abstract

Aim: To determine the analgesic efficacy in early post operative period with out respiratory depression and to determine surgical outcome for patients under laparoscopic pyloromyotomy. Methodology: This study was done at Pediatric surgery operating theatre and Post anesthesia care unit (PACU). Peoples University of Medical and Health Sciences for women (PUMHSW) Nawabshah during the period of 2010-2022. Total 103 cases were observed with n=68 male and n=35 females. Ethical approval was obtained from PUMHSW ethical review board and written informed consent was taken from subjects’ parents or guardians.  Infants of both sexes with 2-4.5 kg weight, age 3-8 weeks and diagnosed cases of infantile hypertrophic pyloric stenosis (IHPS) patients confirm by  ultrasound were included in this study. Patients with the age of more than 2 months, with significant co morbid conditions, required an additional procedure during the operation, and those subjects possess a contraindication to the laparoscopic approach in the opinion of either the surgeon or the anesthesiologist  were excluded from this study. Postoperative pain was measured by using the Neonatal Infant Pain Scale (NIPS) at 30,60,90,120 mins after completion of surgery. Results: In current study 103 patients were participated with male (n=68) to female (35) ratio 1.94:1 with mean age 34.94±7.31 days. Mean weight of the patients were studied 3.08±0.59 kg. Laparoscopic surgical procedure are less painful and patients can be managed by non opioid analgesic combination of intravenous acetaminophen with local anesthetic infiltration to achieved adequate pain relief and avoidance of delayed recovery, postoperative respiratory depression. Conclusion: Laparoscopic pyloromyotomy is safe and effective technique without postoperative respiratory depression and apneic episodes and better surgical outcome especially when opioid sparing multimodal analgesia is given.