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Efficacy of the Game Ready® cooling device on postoperative analgesia after scoliosis surgery in children

  • Myriam Bellon
  • Daphné Michelet
  • Nils Carrara
  • Thomas Vacher
  • Benjamin Gafsou
  • Brice Ilhareborde
  • Keyvan Mazda
  • Emmanuelle Ferrero
  • Anne-Laure Simon
  • Florence Julien-Marsollier
  • Souhayl DahmaniEmail author
Original Article

Abstract

Purpose

The aim of this study was to investigate the opioid-sparing effect of a cooling brace after surgical correction of idiopathic surgery in children.

Methods

We compared two consecutive cohorts of patients before and after introducing this technique in our institution. Management of patients was standardized. The primary objective of the study was to investigate the morphine consumption during the first postoperative day. Secondary outcomes were opioid consumption at day 3, pain intensity (at days 1 and 3), the mobilization in the standing position and duration of hospitalization.

Results

This study included 23 and 22 patients in the control and the cooling cohorts. Cooling brace was associated with a significant decrease in morphine consumption at day 1 (1.7 [0.9, 3.3] versus 1.2 [0.5, 3.2] mg kg−1, P = 0.02) and day 3 (2.5 [0.5, 6.7] versus 1.2 [0.9, 2.5] mg kg−1, P = 0.003), and a reduction in duration of hospitalization (4 [3, 6] versus 3 [3, 4] days, P = 0.004). However, no difference was found on the pain intensity or the percentage of patient mobilized in the standing position. Number of level fused and intraoperative opioid consumption were also different between the two cohorts. However, multivariate analysis found only the use of the cooling brace as significantly associated with opioid consumption at day 1.

Conclusion

The use of this cooling brace allows decreasing the opioid use after surgical correction of idiopathic surgery in children. The current results strongly suggest an interest of this technique in the postoperative management of patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Cooling brace Scoliosis Pain Paediatric 

Notes

Author’s contribution

MB: conceptualized and designed the study, included patients, collected data, corrected the manuscript and approved the final manuscript as submitted. DM: conceptualized and designed the study, included patients, verified statistics, corrected the manuscript and approved the final manuscript as submitted. NC: conceptualized and designed the study, included patients, collected data, corrected the manuscript and approved the final manuscript as submitted. TV: included patients, collected data, corrected the manuscript and approved the final manuscript as submitted. BG: included patients, collected data, corrected the manuscript and approved the final manuscript as submitted. BI: conceptualized and designed the study, corrected the manuscript and approved the final manuscript as submitted. KM: included patients, collected data, corrected the manuscript and approved the final manuscript as submitted. ALS: included patients, conceptualized and designed the study, collected data, verified statistics, corrected the manuscript and approved the final manuscript as submitted. EF: included patients, conceptualized and designed the study, collected data, verified statistics, corrected the manuscript and approved the final manuscript as submitted. FJM: conceptualized and designed the study, collected data, corrected the manuscript. SD: conceptualized and designed the study, designed the data collection instruments, included patients, carried out the initial analyses and verified statistics, drafted the initial manuscript, corrected the manuscript and approved the final manuscript as submitted.

Funding

This study was funded by institutional resources.

Compliance with ethical standards

Conflict of interest

Pr Keyvan Mazda is a consultant for Zymmer®.

Financial Disclosure Statement

Pr Keyvan Mazda is a consultant for Zymmer®.

Supplementary material

586_2019_5886_MOESM1_ESM.pptx (142 kb)
Supplementary material 1 (PPTX 141 kb)
586_2019_5886_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 16 kb)
586_2019_5886_MOESM3_ESM.doc (84 kb)
Supplementary material 3 (DOC 84 kb)

References

  1. 1.
    Duparc-Alegria N, Tiberghien K, Abdoul H, Dahmani S, Alberti C, Thiollier AF (2018) Assessment of a short hypnosis in a paediatric operating room in reducing postoperative pain and anxiety: A randomised study. J Clin Nurs 27:86–91.  https://doi.org/10.1111/jocn.13848 CrossRefGoogle Scholar
  2. 2.
    Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S (2014) Postoperative pain management in children and infants: an update. Paediatr Drugs 16:129–140.  https://doi.org/10.1007/s40272-013-0062-0 CrossRefGoogle Scholar
  3. 3.
    Julien-Marsollier F, David R, Hilly J, Brasher C, Michelet D, Dahmani S (2017) Predictors of chronic neuropathic pain after scoliosis surgery in children. Scand J Pain 17:339–344.  https://doi.org/10.1016/j.sjpain.2017.09.002 CrossRefGoogle Scholar
  4. 4.
    Chidambaran V, Ding L, Moore DL, Spruance K, Cudilo EM, Pilipenko V, Hossain M, Sturm P, Kashikar-Zuck S, Martin LJ, Sadhasivam S (2017) Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study. Eur J Pain 21:1252–1265.  https://doi.org/10.1002/ejp.1025 CrossRefGoogle Scholar
  5. 5.
    Nikolajsen L, Brix LD (2014) Chronic pain after surgery in children. Curr Opin Anaesthesiol 27:507–512.  https://doi.org/10.1097/aco.0000000000000110 CrossRefGoogle Scholar
  6. 6.
    Michelet D, Andreu-Gallien J, Bensalah T, Hilly J, Wood C, Nivoche Y, Mantz J, Dahmani S (2012) A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg 114:393–406.  https://doi.org/10.1213/ANE.0b013e31823d0b45 CrossRefGoogle Scholar
  7. 7.
    Bellon M, Le Bot A, Michelet D, Hilly J, Maesani M, Brasher C, Dahmani S (2016) Efficacy of intraoperative dexmedetomidine compared with placebo for postoperative pain management: a meta-analysis of published studies. Pain Ther 5:63–80.  https://doi.org/10.1007/s40122-016-0045-2 CrossRefGoogle Scholar
  8. 8.
    Michelet D, Hilly J, Skhiri A, Abdat R, Diallo T, Brasher C, Dahmani S (2016) Opioid-sparing effect of ketamine in children: a meta-analysis and trial sequential analysis of published studies. Paediatr Drugs 18:421–433.  https://doi.org/10.1007/s40272-016-0196-y CrossRefGoogle Scholar
  9. 9.
    Zhu A, Benzon HA, Anderson TA (2017) Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review. Anesth Analg 125:1569–1587.  https://doi.org/10.1213/ane.0000000000002434 CrossRefGoogle Scholar
  10. 10.
    Perello M, Artes D, Pascuets C, Esteban E, Ey Batlle AM (2017) Prolonged perioperative low-dose ketamine does not improve short and long-term outcomes after pediatric idiopathic scoliosis surgery. Spine (Phila Pa 1976) 42:E304–E312.  https://doi.org/10.1097/brs.0000000000001772 CrossRefGoogle Scholar
  11. 11.
    Engelhardt T, Zaarour C, Naser B, Pehora C, de Ruiter J, Howard A, Crawford MW (2008) Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery. Anesth Analg 107:1170–1175.  https://doi.org/10.1213/ane.0b013e318183919e CrossRefGoogle Scholar
  12. 12.
    Michelet D, Andreu-Gallien J, Skhiri A, Bonnard A, Nivoche Y, Dahmani S (2016) Factors affecting recovery of postoperative bowel function after pediatric laparoscopic surgery. J Anaesthesiol Clin Pharmacol 32:369–375.  https://doi.org/10.4103/0970-9185.168196 CrossRefGoogle Scholar
  13. 13.
    Cuvillon P, Zoric L, Demattei C, Alonso S, Casano F, L’Hermite J, Ripart J, Lefrant JY, Muller L (2017) Opioid-sparing effect of nefopam in combination with paracetamol after major abdominal surgery: a randomized double-blind study. Minerva Anestesiol 83:914–920.  https://doi.org/10.23736/s0375-9393.17.11508-7 Google Scholar
  14. 14.
    Jin HS, Kim YC, Yoo Y, Lee C, Cho CW, Kim WJ (2016) Opioid sparing effect and safety of nefopam in patient controlled analgesia after laparotomy: A randomized, double blind study. J Int Med Res 44:844–854.  https://doi.org/10.1177/0300060516650783 CrossRefGoogle Scholar
  15. 15.
    Moon JY, Choi SS, Lee SY, Lee MK, Kim JE, Lee JE, Lee SH (2016) The effect of nefopam on postoperative fentanyl consumption: a randomized, double-blind study. Korean J Pain 29:110–118.  https://doi.org/10.3344/kjp.2016.29.2.110 CrossRefGoogle Scholar
  16. 16.
    Su EP, Perna M, Boettner F, Mayman DJ, Gerlinger T, Barsoum W, Randolph J, Lee G (2012) A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br 94:153–156.  https://doi.org/10.1302/0301-620x.94b11.30832 CrossRefGoogle Scholar
  17. 17.
    Ni SH, Jiang WT, Guo L, Jin YH, Jiang TL, Zhao Y, Zhao J (2015) Cryotherapy on postoperative rehabilitation of joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3354–3361.  https://doi.org/10.1007/s00167-014-3135-x CrossRefGoogle Scholar
  18. 18.
    Thijs E, Schotanus MGM, Bemelmans YFL, Kort NP (2018) Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-4962-y Google Scholar
  19. 19.
    Raggio BS, Barton BM, Grant MC, McCoul ED (2018) Intraoperative cryoanalgesia for reducing post-tonsillectomy pain: a systemic review. Ann Otol Rhinol Laryngol 127:395–401.  https://doi.org/10.1177/0003489418772859 CrossRefGoogle Scholar
  20. 20.
    Chughtai M, Sodhi N, Jawad M, Newman JM, Khlopas A, Bhave A, Mont MA (2017) Cryotherapy treatment after unicompartmental and total Knee arthroplasty: a review. J Arthroplasty 32:3822–3832.  https://doi.org/10.1016/j.arth.2017.07.016 CrossRefGoogle Scholar
  21. 21.
    Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Souchet P, Pennecot GF, Mazda K (2008) How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop 28:733–739.  https://doi.org/10.1097/BPO.0b013e318185a36b CrossRefGoogle Scholar
  22. 22.
    Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, Lyon RM, Berens RJ, Weisman SJ (2010) Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg 110:1393–1398.  https://doi.org/10.1213/ANE.0b013e3181d41dc2 CrossRefGoogle Scholar
  23. 23.
    Silins V, Brasher C, Antus F, Michelet D, Hilly J, Grace R, Dahmani S (2017) Predicting postoperative morphine consumption in children. Anaesth Crit Care Pain Med 36:179–184.  https://doi.org/10.1016/j.accpm.2016.08.005 CrossRefGoogle Scholar
  24. 24.
    Matava CT, Crawford MW, Pehora C, Naser B, McDonnell C (2014) Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery. J Opioid Manag 10:39–45.  https://doi.org/10.5055/jom.2014.0190 CrossRefGoogle Scholar
  25. 25.
    Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298.  https://doi.org/10.1001/jamasurg.2016.4952 CrossRefGoogle Scholar
  26. 26.
    Nemet D, Meckel Y, Bar-Sela S, Zaldivar F, Cooper DM, Eliakim A (2009) Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. Eur J Appl Physiol 107:411–417.  https://doi.org/10.1007/s00421-009-1138-y CrossRefGoogle Scholar
  27. 27.
    Patel R, Goncalves L, Leveridge M, Mack SR, Hendrick A, Brice NL, Dickenson AH (2014) Anti-hyperalgesic effects of a novel TRPM8 agonist in neuropathic rats: a comparison with topical menthol. Pain 155:2097–2107.  https://doi.org/10.1016/j.pain.2014.07.022 CrossRefGoogle Scholar
  28. 28.
    Proudfoot CJ, Garry EM, Cottrell DF, Rosie R, Anderson H, Robertson DC, Fleetwood-Walker SM, Mitchell R (2006) Analgesia mediated by the TRPM8 cold receptor in chronic neuropathic pain. Curr Biol 16:1591–1605.  https://doi.org/10.1016/j.cub.2006.07.061 CrossRefGoogle Scholar
  29. 29.
    Davidson A, Howard K, Browne W, Habre W, Lopez U (2012) Preoperative evaluation and preparation, anxiety, awareness, and behavior change. In: Gregory’s pediatric anesthesia. Wiley-Blackwell, pp 273–299Google Scholar
  30. 30.
    Davidson AJ, Shrivastava PP, Jamsen K, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Stargatt R (2006) Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study. Paediatr Anaesth 16:919–927.  https://doi.org/10.1111/j.1460-9592.2006.01904.x CrossRefGoogle Scholar
  31. 31.
    MacLean WE, Green NE, Pierre CB, Ray DC (1989) Stress and coping with scoliosis: psychological effects on adolescents and their families. J Pediatr Orthop 9:257–261CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Myriam Bellon
    • 1
    • 3
    • 4
  • Daphné Michelet
    • 1
    • 3
    • 4
  • Nils Carrara
    • 1
    • 3
    • 4
  • Thomas Vacher
    • 1
    • 3
    • 4
  • Benjamin Gafsou
    • 1
    • 3
    • 4
    • 5
  • Brice Ilhareborde
    • 2
    • 3
    • 4
  • Keyvan Mazda
    • 2
    • 3
    • 4
  • Emmanuelle Ferrero
    • 2
    • 3
    • 4
  • Anne-Laure Simon
    • 2
    • 3
    • 4
  • Florence Julien-Marsollier
    • 1
    • 3
    • 4
  • Souhayl Dahmani
    • 1
    • 3
    • 4
    Email author
  1. 1.Department of Anaesthesia, Intensive Care and Pain Management, Robert Debré University HospitalParis Diderot University, Paris Sorbonne CitéParisFrance
  2. 2.Department of Orthpaedic Surgery, Robert Debré University HospitalParis Diderot University, Paris Sorbonne CitéParisFrance
  3. 3.Paris Diderot UniversityParisFrance
  4. 4.DHU Protect, Robert Debré University HospitalParis Diderot University, Paris Sorbonne CitéParisFrance
  5. 5.Clinique des mousseauxEvryFrance

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