Effekter av ett förändrat postoperativt omhändertagande av spädbarn med sagittal kraniosynostos efter strip kraniotomi med fjäderteknik

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Sammanfattning: Background: Infants with sagittal craniosynostosis have a lower risk of experiencing complications following strip craniotomy with spring-assisted surgery compared to other surgical techniques. Pain treatment with intermittent morphine injections has been proven to be as effective as continuous morphine infusion in postoperative care. Without morphine infusion it has been made possible to shorten the length of stay (LOS) at an Intensive Care Unit (ICU) and cessate the indwelling urinary catheter at an earlier point in time. However, it is not known whether a changed pain regime, earlier cessation of indwelling urinary catheter and shorter LOS at an ICU affect postoperative recovery. Aim: To investigate if a shorter LOS at an ICU, changed postoperative pain regime and earlier cessation of an indwelling urinary catheter affect infants' recovery after spring-assisted surgery for sagittal craniosynostosis. Method: A retrospective comparative case control study with a consecutive selection was conducted. 20 children were cared for according to a standard protocol, and 17 children were treated according to a new protocol. Collection of data was carried out during February 2021, after which descriptive statistics were applied to the material. Results: Infants receiving intermittent morphine injections received significantly less morphine (P = 0.001) and had a significantly shorter time to first feeding (P = 0.036) compared to infants receiving morphine infusion. No difference in respect to pain could be detected. No difference could be established between the groups regarding LOS, and no readmissions to ICU could be observed among infants monitored for a shorter time at ICU. 41 percent of the children cared for according to the new protocol voided within six hours after the urinary catheter was discontinued. No cases of intermittent urinary catheterization were found. Conclusion: A changed pain regime does not lead to increased pain among the infants; it however showed a reduction in morphine consumption and a shorter time to their first feeding. No readmissions to ICU occurred among the children with a shorter LOS at ICU. This leads to the conclusion that infants following spring-assisted surgery can be managed safely at a ward following an earlier transfer from ICU.

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