Peri-operative Analgesia for Single-incision Laparoscopic Appendectomy

Study Overview
=================
Brief Summary
-----------------
Laparoscopic appendectomy is a very common intervention in pediatric surgery. To improve outcomes, some teams have developed the use of single-site laparoscopic appendectomy (SILAP). Nevertheless, there is no consensus yet and no published data on the better perioperative analgesia, and different modalities including general intravenous analgesia, locoregional pre-operative analgesia and local analgesia can be used.

Detailed Description
-----------------
The aim of this retrospective study is to describe the different types of perioperative analgesia routinely used and to compare them to determine the more efficient one for early postoperative pain relief.

Official Title
-----------------
Comparative Retrospective Study on the Different Analgesic Modalities Used for Single-incision Laparoscopic Appendectomy

Conditions
-----------------
Appendicitis

Intervention / Treatment
-----------------
* Procedure: SILAP (single incision laparoscopic appendectomy)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients operated on for appendectomy by SILAP, aged 15 years and under in our pediatric surgical center. Exclusion Criteria: Patients aged 16 years or more. Patients with concomitant pathologies potentially inducing hyper- or hypoesthesia (e.g. cancers, spinal cord injury, etc...) Patients with contraindications for the use of IV analgesics. patients operated on for appendectomy through 3-ports laparoscopy or open surgery. Opposition of the patients and their representative to the study.

Ages Eligible for Study
-----------------
Minimum Age: 1 Day
Maximum Age: 15 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| SILAP patients<br>This cohort is composed by all pediatric patients operated on for SILAP between January 1st, 2012 and August 31, 2022. | Procedure: SILAP (single incision laparoscopic appendectomy)<br>* Appendectomy performed through transumbilical single access laparoscopy, consisting in the removal of the appendix.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess the level of pain after SILAP during the 24 first hours after surgery. | Objectified by the quantity of level 2-3 (in morphin equivalent) analgesic used up to 24 hours after surgery. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess the level of pain as measured by the different pain scales routinely used. | Objectified by the higher level of pain quoted during the first 24 hours after surgery. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 
| To assess the level of pain during the initial post-operative recovery room stay. | Objectified by the higher level of pain quoted during the first 24 hours after surgery and by the amount of level 2-3 analgesic used. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 
| To assess the level of pain after the 24 first hours and until hospital release. | Objectified by the higher level of pain quoted from 24 hours post-operative to hospital discharge, and by the amount of level 2-3 analgesic used. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 
| To assess the different peri-operative local and loco-regional analgesia modalities used and to compare their efficiency. | Objectified by the amount of level 2-3 analgesics used in post-operative recovery room and during hospital stay. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 
| To assess the types and gravity of peri-operative and post-analgesia complications. | Objectified by the description of complications encountered and classified with the Clavien and Dindo gravity scale for surgical complications. | Up to 16 years of age. From the date of surgery until the end of hospital stay, assessed up to 16 years of age | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
appendectomy, single-site laparoscopy, analgesia, pain, peri-operative management