Multimodal Analgesia in Major Abdominal Pediatric Cancer Surgeries

Surgical trauma initiates multiple physiological mechanisms that cause postoperative pain. Postoperative pain has nociceptive, inflammatory, and neuropathic components.Inadequate relief of postoperative pain leads to significant morbidity, delayed recovery, and mortality.Adverse reactions of medications used for postoperative pain management, particularly opioids, are common including pruritus and nausea and vomiting.Preemptive analgesia is defined as analgesic treatment that starts before surgical incision to prevent central sensitization caused by incisional and inflammatory injuries.Therefore, in this pilot study, the investigators are trying to evaluate safety and efficacy of preemptive multimodal analgesia compared with preemptive caudal analgesia and PCA morphine in pediatric cancer patient undergoing major abdominal surgery.

Sex

All

Minimum age

5 Years

Maximum age

12 Years

Inclusion Criteria:

* were ASA I or II patients.
* Aged between 5 and 12 years.
* Both sexes.
* Scheduled for major abdominal surgery with a midline incision.

Exclusion Criteria:

* included history of mental retardation or delayed development that may interfere with pain intensity assessment,
* Known or suspected allergy to any administered drugs.
* Active renal (creatinine clearance \<50).
* Hepatic (liver enzymes more than 10 folds).
* Respiratory (SPO2 \<92% on room air).
* Cardiac disease (ejection fraction \< 50%).