Effect of Prophylactic Vitamin D Supplementation on Postoperative Pain and Sedation in Children with Mental Motor Retarded Who Undergoing Dental Treatment Introduction

Year 2023, Volume: 6 Issue: 1, 67 - 74, 30.04.2023

Ebru Biricik , Nilgün Alpay , Feride Karacaer , Volkan Ciftci , Murat Türkeün Ilgınel , Ozlem Goruroglu Ozturk , Dilek Özcengiz

https://doi.org/10.36516/jocass.1216326

Abstract

Öz
Amaç: Mental motor retardasyonu (MMR) olan çocuklarda D vitamini eksikliği sıklığı daha yüksektir. Bu çalışmada genel anestezi altında diş tedavisi uygulanan MMR çocuklarda D vitamini takviyesinin postoperatif ağrı üzerine etkisini araştırmayı amaçladık.
Gereç-Yöntem: Yaşları 7-17 arasında değişen MMR'li toplam 62 hastaya diş tedavisi planlandı. Katılımcılar iki gruba ayrıldı. Çocuklara D vitamini (günde 600 IU D vitamini) veya Salin reçete edildi. Serum D vitamini düzeyleri ölçüldü. Katılımcılar oral D vitamini 600 IU (Grup D) veya 2 ml salin (Grup C) alımını 12. hafta boyunca devam ettirdiler. Tüm katılımcılar postoperatif 1. saate kadar gözlendi ve Non-communicating Children’s Pain Checklist–Postoperative Version (NCCPC-PV), Ramsay sedasyon skorları, anestezi sonrası bakım ünitesinde kalış süreleri, analjezik gereksinimleri kaydedildi.
Bulgular: Çalışma elli çocuk (Grup D' de 35, Grup C' de 15) ile tamamlandı. 12. hafta serum D vitamini düzeyleri Grup D' de Grup C' ye göre yüksekti (p=0,007). İlk başvuruda Grup D’ de 13 (%37,1) Grup C’ de 6 (%40) hastada D vitamini eksikliği, grup D’ de 8 (%51,4) ve Grup C’ de 7 (%46,7) hastada D vitamini yetersizliği. PACU' da 15., 30. ve 60. dakikalarda NCCPC-PV skorunda gruplar arasında istatistiksel olarak anlamlı fark vardı (p<0.05). Ancak Ramsey skorları tüm zamanlarda iki grup arasında benzerdi.
Sonuç: MMR çocuklarda serum D vitamini düzeyleri düşük olarak tespit edildi. D vitamini takviyesinin postoperatif 1. saatte ağrı skorlarını azaltabildiği gözlemlendi.

Keywords

postoperatif analjezi, vitamin D, mental motor retardasyon

Effect of Prophylactic Vitamin D Supplementation on Postoperative Pain and Sedation in Children with Mental Motor Retarded Who Undergoing Dental Treatment Introduction

Abstract

The frequency of vitamin D deficiency is higher in children with mental motor retardation(MMR). We aimed to investigate the effect of vitamin D supplementation on postoperative pain in children with MMR who underwent dental treatment under general anesthesia.
Materials-Methods: Dental treatment was planned for a total of 62 patients with MMR, aged 7-17 years. Participants were divided into two groups. Children were prescribed vitamin D (600 IU of vitamin D per day) or Saline. Serum vitamin D levels were measured. Participants continued to intake oral vitamin D 600 IU (Group D) or 2ml saline (Group C) throughout 12 weeks. All participants were observed postoperative 1st hour, and Non-communicating Children's Pain Checklist–Postoperative Version (NCCPC-PV), Ramsay sedation scores, length of stay in post-anesthesia care unit, and analgesic requirements were recorded.
Results: The study was completed with fifty children (35 in Group D, 15 in Group C). Serum vitamin D levels were higher in Group D than Group C at 12 weeks(p=0.007). Vitamin D deficiency was found at 13 patients (37.1%) and 6 (40%), and vitamin D sufficiency was found 18 (51.4%) and 7 (46.7%) in Groups D and C, respectively at first admission. There was statistically significant difference between groups in NCCPC-PV score at 15th, 30th and 60th minutes in PACU(p<0.05). However, Ramsey scores were similar between two groups at all times.
Conclusion: Serum vitamin D levels were found to be low in MMR children. It was observed that vitamin D supplementation could reduce pain scores in 1st postoperative hour.

Keywords

Postoperative analgesia, vitamin D, mental motor retardation

References

• 1. Durkin M, Schupf N, Stein Z et al. Mental retarda¬tion. In. Wallace R, editor. Stamford, CT: Apple¬ton & Lange; Public health and preventive medi¬cine. 2007:1173-84.
• 2. Taylor SN. Vitamin D in Toddlers, Preschool Chil-dren, and Adolescents. Ann Nutr Metab. 2020; 76: 30-41. https://doi.org/10.1159/000505635
• 3. Harvey RA, Champe PC. Biyokimya Lippincott's Illustrated Reviews (Çev. Edt. Ulukaya E.) 5. Ün-ite Metabolizmasının düzenlenmesi, 28. Bölüm Vitaminler (Çev: Delen Akçay Y), 3.baskı, İstan-bul: Nobel Tıp Yayınevi; 2007: 384-87.
• 4. Akpinar P. Vitamin D status of children with cere-bral palsy: Should vitamin D levels be checked in children with cerebral palsy? North Clin Istanb. 2018;5:341-7. https://doi.org/10.14744/nci.2017.09581
• 5. Manohar S, Gangadaran RP. Vitamin D status in children with cerebral palsy. Int J Contemp Pedi-atr. 2017; 4: 615.
• 6. Seth A, Aneja S, Singh R et al. Effect of impaired ambulation and anti-epileptic drug intake on vita¬min D status of children with cerebral palsy. Pae¬diatr Int Child Health. 2017;37: 193-8. https://doi.org/10.1080/20469047.2016.1266116
• 7. Straube S, Derry S, Moore RA et al. Vitamin D for the treatment of chronic painful conditions in adults. The Cochrane Database of Systematic Re¬views. 2010;(1)CD007771 https://doi.org/10.1002/14651858.CD007771.pub2
• 8. Huang W, Shah S, Long Q et al. Improvement of pain, sleep, and quality of life in chronic pain pa-tients with vitamin D supplementation. Clin J Pain. 2013;29:341-7. https://doi.org/10.1097/AJP.0b013e318255655d
• 9. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81. https://doi.org/10.1056/NEJMra070553
• 10. Van Veldhuizen PJ, Taylor SA, Williamson S et al. Treatment of vitamin D deficiency in patients with metastatic prostate cancer may improve bone pain and muscle strength. J of Urol. 2000;163:187-90. https://doi.org/10.1016/S0022-5347(05)68001-9
• 11. Shams T, Al Wadani H, El-Masry R et al. Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease. Anaesthesiol Clin Pharmacol. 2014;30:20-4. https://doi.org/10.4103/0970-9185.125692
• 12. Bose S, Khanna A, You J et al. Low serum vitamin D levels are not associated with increased postop¬erative pain and opioid requirements: a historical cohort study. Can J Anesth. 2015;62:770-6. https://doi.org/10.1007/s12630-015-0357-4
• 13. Hajimohammadebrahim-Ketabforoush M, Shahmohammadi M, Khoundabi B et al. Effect of Vitamin D Supplementation on Postcraniotomy Pain After Brain Tumor Surgery: A Randomized Clinical Trial. World Neurosurg. 2019;130:105-11. https://doi.org/10.1016/j.wneu.2019.05.250
• 14. Rusińska A, Płudowski P, Walczak M et al. Vita-min D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Defi¬ciency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel with Participation of Na¬tional Specialist Consultants and Representatives of Scientific Societies-Update. Front Endocrinol. 2018;9:246. https://doi.org/10.3389/fendo.2018.00246
• 15. Breau LM, Finley GA, McGrath PJ et al. Valida-tion of the non-communicative pain checklist-postoperative version. Anesthesiology 2002; 96:528-35. https://doi.org/10.1097/00000542-200203000-00004
• 16. Mason KP, Michna E, Zurakowski D et al. Value of bispectral index monitor in differentiating be-tween moderate and deep Ramsay Sedation Scores in children. Paediatr Anaesth. 2006;16:1226-31. https://doi.org/10.1111/j.1460-9592.2006.01975.x
• 17. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924. https://doi.org/10.1213/00000539-197011000-00020
• 18. Munns CF, Shaw N, Kiely M al. Global Consensus Recommendations on Prevention and Manage¬ment of Nutritional Rickets. J Clin Endocrinol Metab. 2016;101:394-415. https://doi.org/10.1210/jc.2015-2175
• 19. Botelho J, Machado V, Proença L et al. Vitamin D Deficiency and Oral Health: A Comprehensive Re¬view. Nutrients. 2020;19;12:1471. https://doi.org/10.3390/nu12051471
• 20. Bashutski JD, Eber RM, Kinney JS et al. The Im-pact of Vitamin D Status on Periodontal Surgery Outcomes. J Dent Res. 2011;90:1007-12. https://doi.org/10.1177/0022034511407771
• 21. Le Roy C, Barja S, Sepúlveda C et al. Vitamin D and iron deficiencies in children and adolescents with cerebral palsy. Neurologia (Engl Ed). 2021;36:112-8. https://doi.org/10.1016/j.nrl.2017.11.005
• 22. Schwalfenberg G. Improvement of chronic back pain or failed back surgery with vitamin D reple-tion: a case series. J Am Board Fam Med. 2009;22:69-74. https://doi.org/10.3122/jabfm.2009.01.080026
• 23. Lee A, Chan SKC, Samy W et al. Effect of Hypo-vitaminosis D on Postoperative Pain Outcomes and Short-Term Health-Related Quality of Life After Knee Arthroplasty: A Cohort Study. Medi-cine (Baltimore). 2015;94:1812. https://doi.org/10.1097/MD.0000000000001812