Transcript SLOVENSKO ZDRAVNIŠKO DRUŠTVO SEKCIJA KIRURGOV …

DEPARTMENT OF PEDIATRIC SURGERY
GENERAL TEACHING HOSPITAL CELJE
SLOVENIA
ANALGESIA IN PEDIATRIC SURGERY
( HOW TO MANAGE POSTOPERATIVE PAIN IN CHILDREN )
ANALGEZIJA PRI OPERIRANIH OTROCIH.
( LAJŠANJE POOPERATIVNE BOLEČINE PRI OTROCIH )
Prof. Silvo Lipovšek, dr. med.
PEDIATRIC SURGEON AND PROFESSOR OF PEDIATRIC SURGERY
1. KONGRES SLOVENSKEGA ZDRUŽENJA ZA ZDRAVLJENJE BOLEČINE ( SZZB )
IN SIMPOZIJ O KLINIČNI NEVROFIZIOLOGIJI BOLEČINE
9. – 10. OKTOBRA 2009.
Bled. SLOVENIJA.
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Prof. SILVO LIPOVŠEK
M.D.
Born : 29/08/1948 in Buenos Aires. ARGENTINA.
1974. graduate MD. Medical School, University of Buenos Aires. ARG
PROFESSOR OF PEDIATRIC SURGERY. School of Health Sciences. ARG.
VISITING ASSOCIATE PROFESSOR OF SURGERY. UCHSC. Colorado. USA.
UNIVERSITY DOCENT: of Anathomy, Pathology and Pediatrics. School of Medicine. Bs Aires University. ARG.
RESIDENT of PEDIATRIC SURGERY. Children’s Hospital. Buenos Aires. ARG.
FELLOWSHIP PEDIATRIC SURGEON. surgical training for Anorectal malformations. Scneider’s Children
Hospital. New York. USA.
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VISITING PEDIATRIC SURGEON. Surgical training for neonatal surgery. Childrens Hospital. Denver. Colorado. USA.
SPECIALIST PEDIATRIC SURGEON.
SPECIALIST PEDIATRICIAN.
SPECIALIST HOSPITALARY MANAGEMENT AND ADMINISTRATION.
SIX (6) RECERTIFICATIONS of Specialist Titles
VICE CHIEF OF PEDIATRIC SURGERY. Argentine Federal Police Hosp. Buenos Aires. ARG
CHIEF DEPARTMENT OF PEDIATRIC SURGERY. General Hospital “Dr. Diego Thompson”. ARG.
HONORARY MEMBER: Peruvian Association of Paediatric Surgeons and Ecuadorian Association of Paediatric Surgeons
ACTIVE MEMBERSHIP: Argentine Association of Paediatrics Surgeons, Pan-American Association of Paediatric
Surgeons, Argentine Association of Surgeons, Argentine Association of Paediatricians, Association of Anathomists of the River Plate,
Argentine Association of Morphologic Sciences. European Paediatric Surgery Association ( EUPSA ) Slovenian Association of Pediatric
Surgery ( SAOPS ), Slovenian Association of Traumatology.
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* SEVEN (7) MEDICAL AWARDS.
* 43 ACTIVE PARTICIPATIONS IN MEDICAL MEETINGS AND CONGRESSES in
ARGENTINA. * 16 ACTIVE PARTICIPATIONS IN FOREING MEDICAL MEETINGS .
* 28 COURSES OF MEDICAL EDUCATION in ARGENTINA. * 6 FOREING COURSES OF
MEDICAL EDUCATION.
* COAUTOR of the Book »PEDIATRIC HANDBOOK« Prof. Dr. Jose Maria Albores. ARG. *
AUTOR AND COAUTOR of 75 Scientific Medical Researches.
* DEFINITELY MOVED TO SLOVENIA IN MARCH 2003.
* FOUNDER MEMBER AND SECRETARY OF THE SLOVENIAN ASSOCIATION OF PEDIATRIC
SURGERY ( SAOPS )
* CURRENT POSITION: - SURGEON at the Department of Pediatric Surgery.
General Teaching Hospital Celje.
DEPARTMENT OF PEDIATRIC SURGERY
GENERAL TEACHING HOSPITAL CELJE
SLOVENIA
ANALGESIA IN PEDIATRIC SURGERY
( HOW TO MANAGE POSTOPERATIVE PAIN IN CHILDREN )
ANALGEZIJA PRI OPERIRANIH OTROCIH.
( LAJŠANJE POOPERATIVNE BOLEČINE PRI OTROCIH )
Prof. Silvo Lipovšek, dr. med.
PEDIATRIC SURGEON AND PROFESSOR OF PEDIATRIC SURGERY
1. KONGRES SLOVENSKEGA ZDRUŽENJA ZA ZDRAVLJENJE BOLEČINE ( SZZB )
IN SIMPOZIJ O KLINIČNI NEVROFIZIOLOGIJI BOLEČINE
9. – 10. OKTOBRA 2009.
Bled. SLOVENIJA.
PACIENT
IMA PRAVICO DO
PREPREČEVANJA
IN LAJŠANJA
TRPLJENJA
THE PACIENT
HAS THE
RIGHT TO
PREVENTION
OF
SUFFERING
AND PAIN
RELIEF
CHILDREN ARE WEAKER BY NATURE.
SO, POSTOPERATIVE PAIN RELIEF
IS ALSO A BASIC RIGHT
OTROCI SO PO NARAVI ŠIBKEJŠI, ZATO
JE LAJŠANJE POOPERATIVNE BOLEČINE
TEMELJNA PRAVICA
PAIN IN CHILDREN
HAS A CRUCIAL IMPACT ON HIS NORMAL
ACTIVITIES
BOLEČINA PRI OTROCIH ZELO VPLIVA NA SVOJE
NORMALNO VSAKODNEVNO ŽIVLJENJE
IN JE PODCENJENO ŠE DANES !..
NA ŽALOST
LAJŠANJE POOPERATIVNE BOLEČINE
JE BILO DOLGO LET PODCENJENO
UNFORTUNATELY
POSTOPERATIVE PAIN RELIEF HAS BEEN
UNDERESTIMATED FOR A LONG TIME
AND STILL IS.
PAIN IN CHILDREN AND NEONATES
IS EVEN MORE HARMFUL THAN IN ADULTS
BOLEČINA PRI OTROCIH JE BOLJ ŠKODLJIVA,
KOT PRI ODRASLIH
POOPERATIVNA BOLEČINA PRI OTROCIH POVZROČA
TRPLJENJE, SLABO KAKOVOST ŽIVLJENJA,
IN PUSTI, ( V ZAČETKU NEVIDNE )
DOLGOTRAJNE PSIHOLOŠKE TRAVMATIČNE POSLEDICE
SCIENTIFIC
RESEARCHES
HAS SHOWN
THAT IN THE
POSTOPERATIVE
PERIOD
ZNANSTVENE
RAZISKAVE SO
STROKOVNO IN
BREZ DVOMA
DOKAZALE, DA V
POOPERATIVNEM
OBDOBJU
75 %
75 %
OF
CHILDREN FEEL
OTROK OBČUTI
MODERATE
ZMERNE DO
TO
INTENSIVE PAIN
MOČNE BOLEČINE
ZNANJA IN RAZISKAVE
V PODROČJU
NEVROFIZIOLOGIJE,
FARMAKODINAMIKE IN
KLINIČNE FARMACOLOGIJE
SO IZREDNO NAPREDOVALE.
UPORABA ZDRAVIL
ZA LAJŠANJE BOLEČINE
PRI OTROCIH JE DANES
VELIKO BOLJ VARNA
INTENSIVE RESEARCH HAS BEEN
CARRIED OUT INTO PAIN IN
CHILDREN IN THE LAST
TWO DECADES IN THE AREA
OF NEUROPHYSIOLOGY AND
CLINICAL PHARMACOLOGY,
LEADING TO GREATER INSIGHTS
INTO THE PHARMACOKINETIC
EFFECTS OF DRUGS IN TREATMENT
OF PAIN IN CHILDREN
FURTHERMORE ,
IT HAS BEEN DEMONSTRATED THAT :
PERIPHERAL, SPINAL AND SUPRASPINAL
AFFERENT PAIN PATHS
ARE ALREADY BEING DEVELOPED IN A :
“ 26 WEEKS NONATE ”
IN THE “NEWBORN”
THE INSUFFICIENT TREATMENT OF
ACUTE POSTOPERATIVE PAIN
CAUSE !..
LONGTERM DECREASE OF THE PAIN LEVEL.
IN OLDER CHILDREN
INSUFFICIENT TREATMENT OF POSTOPERATIVE PAIN
E X T E N D S !..
POSTOPERATIVE CARE
AND DELAYS QUICK RETURN TO NORMAL LIFE.
IT IS THEREFORE OF
PARAMOUNT IMPORTANCE
THAT ALL PHYSICIANS
UNDERSTAND THE HARMFUL
EFFECTS OF POSTOPERATIVE
PAIN IN CHILDREN, NEONATES
AND PREMATURE INFANTS,
AND HIS CONSEQUENCES.
BUT… IN SPITE
OF THESE ADVANCEMENTS…
TREATMENT OF PAIN IN CHILDREN,
IS STILL… UNDERESTIMATED !..
NESPREJEMLJIVO JE !..
DA NE GLEDE NA VSE
PREPRIČLJIVE DOKAZE IN
NAPREDKE NA TEM PODROČJU,
ŠE VEDNO OBSTAJA TA
PODCENJENOST PRI VEČINI
KIRURGOV IN ZDRAVNIKOV
OTROKE NE SME BOLET PO OPERACIJI, NE
GLEDE NA STARE PRESODKE, DOKTRINE IN
DRUGE NA PAMET NAUČENA PRAVILA
IT IS UNACCEPTABLE !..
THAT WITH ALL PROGRESS,
TODAY MANY SURGEONS STILL
DENY THE NEED OF TREATMENT
OF POSTOPERATIVE PAIN
IN CHILDREN
CHILDREN HAVE THE RIGHT TO
PAINLESS POSTOPERATIVE STATUS
AND SURGEONS MUST DEFEND THAT
RIGHT WITHOUT OLD CONCEPTS OR
PREJUDICES.
BASED ON EXTENSIVE WORLD LITERATURE AND
RESEARCHES IN THIS DOMAIN, WE PRESENT OUR EXPERIENCE,
FROM 2005 TO NOW , IN THE DEPARTMENT OF PEDIATRIC
SURGERY AT THE GENERAL TEACHING HOSPITAL CELJE,
THE FIRST CENTRE TO PERFORM THIS TECHNIQUE IN SLOVENIA
PRVI PRISPEVEK V SLOVENIJI,
KI JE OMENIL IN OPOZORIL POMEMBNOST LAJŠANJA POOPERATIVNE BOLEČINE PRI OTROCIH
JE BIL OBJAVLJEN NA IV. KONFERENCI SLOVENSKIH ZDRAVNIKOV IZ SVETA IN SLOVENIJE
V NOVEM MESTU LETA 2005.
TREATMENT OF PAIN IN PEDIATRIC SURGERY
ZDRAVLJENJE POOPERATIVNE BOLEČINE V OTROŠKI KIRURGIJI
LIPOVŠEK SILVO, dr, med.
V LJUBLJANI LETA 2007, SE JE PREDSTABILA PRVA RAZISKAVA
NA TEM PODROČJU V SLOVENIJI
EVALUATION OF A METHOD FOR TREATMENT OF POSTOPERATIVE PAIN IN PEDIATRIC SURGERY
( FIRST RESEARCH IN SLOVENIA )
OCENA METODE ZA LAJŠANJE POOPERATIVNE BOLEČINE NA OTROŠKI KIRURGIJI
( PRVA RAZISKAVA V SLOVENIJI )
LIPOVŠEK SILVO, dr. med.
DO SEDAJ SMO PREDSTAVILI IN OBJAVILI MNOGO PRISPEVKOV V SLOVENIJI IN TUJINI
GLEDE LAJŠANJA POOPERATIVNE BOLEČINE PRI OTROCIH ,
Z METODO INFILTRACIJE OPERATIVNE RANE Z LEVOBUPIVAKAINOM
OSREDOTOČENI NA TAKO IMENOVANI OTROŠKI VISCERALNI KIRURGIJI
THE METHOD APPLIED IS THE :
“INFILTRATION OF THE OPERATIVE WOUND”
AT THE END OF SURGERY
WITH A “LONG-ACTING” LOCAL ANAESTHETIC.
THE LONG-ACTING LOCAL ANAESTHETIC
WE USED FOR INFILTRATION OF THE
OPERATIVE WOUND IN OUR
INVESTIGATION IS:
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LEVOBUPIVACAINE: ( CHIROCAINE TM. )
DOSE: 1-2 mg / kg.
NUMBER OF CHILDREN OPERATED
( 01/06/2005 – 30/05/2009 )
1618
CHILDREN
AGE : 1 m – 17 years
WEIGHT : 4 kg – 68 kg
PATIENTS
WITH
933
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AGES:
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PATIENTS
INFILTRATION OF OPERATIVE WOUND
WEIGHT:
WITHOUT
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1 m – 16 y
4 kg – 62 kg
INFILTRATION OF OPERATIVE WOUND
685
( 42,3 % )
1 m – 17 y
WEIGHT: 5kg – 68 kg
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( 57,7% )
AGES:
COMPARISON
01/06/2005
31/12/2006
607
153
25,2%
454
74,8 %
01/01/2007
31/05/2009
1011
780
77,2%
231
22,8%
STANDARD VISUAL SCORE
WAS USED FOR EVALUATION
OF POSTOPERATIVE PAIN.
 EVALUATION OF POSTOPERATIVE PAIN WAS
REPORTED BY:
 CHILD, PARENTS, NURSES and SURGEONS.
COMPLICATIONS.
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NO
CARDIAC or RESPIRATORY COMPLICATIONS.
NO WOUND BLEEDING.
 NO WOUND INFECTION.
 NO WOUND LEAKING.
 NO WOUND DEHISCENCE.
 NO WOUND NECROSIS.
 NO NERVES INJURY.
 NO VASCULAR INJURY.
NO MAJOR or MINOR ACCIDENTS.
 NO DRUG ALLERGY.
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EFFECTIVE TIME of ANAESTHESIA
in THE OPERATIVE WOUND.
( infiltrated with levobupivacaine )
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Minimal
time of anaesthesia effects:
( painless time ) :
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Maximal
11.30
hours.
time of anaesthesia effects:
( painless time ) :
18.00
hours.
RESULTS & BENEFITS.
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EARLY, SIGNIFICANT and EFFECTIVE... MITIGATION OF POSTOPERATIVE
PAIN.
LONG TIME... OF ANALGESIA.
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EARLY RISE... FROM BED.
REDUCED USE... OF ANALGETICS AFTER SURGERY.
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SHORT STAY... IN HOSPITAL.
BETTER POSTOPERATIVE... QUALITY OF LIFE.
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QUICK RETURN... TO NORMAL LIFE.
LOW or MINIMAL... PSICOLOGIC TRAUMA AFTER SURGERY.
RESULTS & BENEFITS.
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BETTER RELATIONSHIP... between CHILD and SURGEON.
BETTER RELATIONSHIP... between CHILD and NURSING STAFF.
BETTER RELATIONSHIP... between PARENTS and NURSING STAFF.
LESS INTERPERSONAL CONFLICTS... DURING HOSPITALIZATION.
OUTSTANDING PROTECTION... FOR YOUNG PACIENT’S ORGANISM.
( due to a smaller consumption of analgetics. )
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SIGNIFICANT... SAVINGS.
COMPARISON with NOT INFILTRATED GROUP.
SURGEONS and NURSING STAFF...
“UNANIMOUS”... REMARKED :
“A SIGNIFICANT DIFFERENCE EXIST BETWEEN BOTH GROUPS”.
THE INFILTRATED GROUP HAVE :
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BETTER POSTOPERATIVE BEHAVIOR.
GOOD RELATIONSHIP WITH NURSES and SURGEONS.
 BEST SENSE OF HUMOR.
 BETTER DISPOSITION TO GAMES.
 THEY ARE MORE HAPPY and SMILE.
and
 THEY DON’T CRY SO MUCH.
CHILD WITHOUT PAIN…
IS RELAXED, HAPPY AND SMILES !..
IF EVEN THOUGH… PASSED SURGERY.
THIS ?
THAT ?
CHILDREN DESERVE THE
OFFER OF NEWEST
METHODS TO TREAT
POSTOPERATIVE PAIN
THEY HAVE THE RIGHT
TO A PAINLESS
POSTOPERATIVE
STATUS
SURGEONS HAVE THE
OBLIGATION TO FULFIL
BOTH , IN SPITE OF OLD
CONCEPTS CURRENTLY
STILL BEING APPLIED
ZAKLJUČEK :
UPORABA METODE INFILTRACIJE
OPERATIVNE RANE Z
DOLGOTRAJNIM LOKALNEM
ANESTETIKOM PRI OTROCIH
KAŽE, DA JE :
UČEN POVAR
UČ
EN
INKOVIT.
OSTAVEN.
PO
CENI.
VAR
EN.
CONCLUDING :
INFILTRATION OF THE OPERATIVE
WOUND WITH LEVOBUPIVACAINE
IN PEDIATRIC SURGERY
IS:
CH E S S
CH
EAP.
E FFECTIVE.
S AFE.
S IMPLE.
THANKS FOR YOUR ATTENTION !..