Top

Pediatric Surgery International

Published in:

01-11-2015 | Original Article

Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control

Authors: M. S. Machoki, A. J. W. Millar, H. Albetyn, S. G. Cox, J. Thomas, A. Numanoglu

Published in: Pediatric Surgery International | Issue 11/2015

Abstract

Introduction

Local anesthetic wound infusion has shown promising results in adults. Its use in children is limited to some centers and there are only a few prospective trials in this group of patients.

Methods

Sub-fascial continuous local anaesthetic wound infusion (CLAWI) (0.2 % Bupivacaine) plus intravenous paracetamol and rescue intravenous morphine was compared to: (a) Epidural bupivacaine (EPI) plus paracetamol and rescue intravenous morphine for patients undergoing laparotomy. (b) Intravenous morphine and paracetamol (standard post-operative analgesia—SAPA) in children undergoing Lanz incision laparotomy for complicated appendicitis. ‘InfiltralLong’, PANJUNK^® catheters were placed sub-fascially after peritoneal closure for post-operative bupivacaine infusion. Pain scores were recorded regularly by the same blinded pain specialist. The primary outcomes were pain control and total morphine. The secondary outcomes were time to full feeds, mobilization requirement for urinary catheter and complications.

Results

Sixty patients (18 laparotomy-CLAWI, 17 laparotomy-EPI and 12 appendectomy-CLAWI, and 13 appendectomy-SAPA) were analyzed. The average pain score was 2.5 (1–4) in the CLAWI groups, 3.0 (1–5) in the EPI group and 3.5 (2–5) in the SAPA group. Morphine requirements were markedly less for CLAWI. SAPA and EPI groups required urinary catheters for longer and took longer to mobilize (average 4 days compared to 2 days for CLAWI). There were no wound or bupivacaine complications in the CLAWI group.

Conclusion

Continuous subfascial bupivacaine infusion is reliable, safe and effective in paediatric post-operative pain control with considerably reduced opiate requirements.

Anand KJ, Hickey PR (1987) Pain and its effects in the human neonate and fetus. N Engl J Med 317:1321–1329. doi:10.1056/NEJM198711193172105 CrossRefPubMed

Simons SHP, Tibboel D (2006) Pain perception development and maturation. Semin Fetal Neonatal Med 11:227–231. doi:10.1016/j.siny.2006.02.010 CrossRefPubMed

Taddio A, Katz J, Ilersich AL, Koren G (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349:599–603. doi:10.1016/S0140-6736(96)10316-0 CrossRefPubMed

Ingelmo PM, Gelsumino C, Acosta AP et al (2007) Epidural analgesia in children: planning, organization and development of a new program. Minerva Anestesiol 73:575–585PubMed

Polaner DM, Drescher J (2011) Pediatric regional anesthesia: what is the current safety record? Paediatr Anaesth 21:737–742. doi:10.1111/j.1460-9592.2010.03499.x CrossRefPubMed

Hall RW, Kronsberg SS, Barton BA et al (2005) Morphine, hypotension, and adverse outcomes among preterm neonates: who’s to blame? Secondary results from the NEOPAIN trial. Pediatrics 115:1351–1359. doi:10.1542/peds.2004-1398 CrossRefPubMed

Duedahl TH, Hansen EH (2007) A qualitative systematic review of morphine treatment in children with postoperative pain. Paediatr Anaesth 17:756–774. doi:10.1111/j.1460-9592.2007.02213.x CrossRefPubMed

Fustran Guerrero N, Dalmau Llitjós A, Sabaté Pes A (2011) Continuous infusion of local anesthetic at the site of the abdominal surgical wound for postoperative analgesia: a systematic review. Rev Esp Anestesiol Reanim 58:337–344CrossRefPubMed

Tirotta CF, Munro HM, Salvaggio J et al (2009) Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery. Pediatr Anesth 19:571–576. doi:10.1111/j.1460-9592.2009.03009.x CrossRef

10.

Wang LW, Wong SW, Crowe PJ et al (2010) Wound infusion with local anaesthesia after laparotomy: a randomized controlled trial. ANZ J Surg 80:794–801. doi:10.1111/j.1445-2197.2010.05339.x CrossRefPubMed

11.

White PF, Kehlet H (2010) Improving postoperative pain management: what are the unresolved issues? Anesthesiology 112:220–225. doi:10.1097/ALN.0b013e3181c6316e CrossRefPubMed

12.

Hermansson O, George M, Wester T, Christofferson R (2013) Local delivery of bupivacaine in the wound reduces opioid requirements after intraabdominal surgery in children. Pediatr Surg Int 29:451–454. doi:10.1007/s00383-013-3296-6 CrossRefPubMed

13.

Lan KKG, Demets DL (1983) Discrete sequential boundaries for clinical trials. Biometrika 70:659–663. doi:10.1093/biomet/70.3.659 CrossRef

14.

O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35:549–556CrossRefPubMed

15.

Ortega G, Rhee DS, Papandria DJ et al (2012) An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res 174:33–38. doi:10.1016/j.jss.2011.05.056 CrossRefPubMed

16.

JSTOR (1986) Infection control 7(3):193–200. http://www.jstor.org/discover/10.2307/30145058?uid=3739368&uid=2&uid=4&sid=21104192981271. Accessed 20 Sep 2014

17.

Anand KJ (2000) Effects of perinatal pain and stress. Prog Brain Res 122:117–129CrossRefPubMed

18.

Taylor EM, Boyer K, Campbell FA (2008) Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag J Can Pain Soc J la société Can pour le Trait la douleur 13:25–32

19.

Hidas G, Kelly MS, Watts B et al (2015) Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery: prospective randomized controlled trial. J Pediatr Surg 50(3):481–484. doi:10.1016/j.jpedsurg.2014.07.015 CrossRefPubMed

20.

Lu C-W, Lin T-Y, Shieh J-S et al (2013) Antimicrobial effect of continuous lidocaine infusion in a Staphylococcus aureus-induced wound infection in a mouse model. Ann Plast Surg 1. doi:10.1097/SAP.0b013e318276d8e7

21.

Kose AA, Karabaggli Y, Kiremitci A et al (2010) Do local anesthetics have antibacterial effect on Staphylococcus aureus under in vivo conditions? An experimental study. Dermatologic Surg 36:848–852. doi:10.1111/j.1524-4725.2010.01559.x CrossRef

22.

Sams VG, Lawson CM, Coan P et al (2012) Effect of local anesthetic on microorganisms in a murine model of surgical site infection. J Trauma Acute Care Surg 73:441–445. doi:10.1097/TA.0b013e3182583e4f (discussion 445–446) CrossRefPubMed

23.

Hollmann MW, Duriex ME (2000) Local Anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 93(3):858–875CrossRefPubMed

24.

Hancı V, Hakimoğlu S, Özaçmak H et al (2012) Comparison of the effects of bupivacaine, lidocaine, and tramadol infiltration on wound healing in rats. Rev Bras Anestesiol 62:799–810. doi:10.1016/S0034-7094(12)70180-0 CrossRefPubMed

25.

Anakwenze OA, Hosalkar H, Huffman GR (2010) Case reports: two cases of glenohumeral chondrolysis after intraarticular pain pumps. Clin Orthop Relat Res 468:2545–2549. doi:10.1007/s11999-010-1244-5 PubMedCentralCrossRefPubMed

26.

Tilleul P, Aissou M, Bocquet F et al (2012) Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery. Br J Anaesth 108:998–1005. doi:10.1093/bja/aes091 CrossRefPubMed

27.

Wild TT, Chalmers DJ, Bielsky A, Wilcox DT (2014) How do I do it: continuous local anesthetic infusion for children with spinal dysraphism undergoing major reconstruction of the lower urinary tract. J Pediatr Urol 10:394–395. doi:10.1016/j.jpurol.2013.12.005 CrossRefPubMed

Title: Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control
Authors: M. S. Machoki
A. J. W. Millar
H. Albetyn
S. G. Cox
J. Thomas
A. Numanoglu
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 11/2015
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-015-3796-7

At a glance: The STEP trials

Springer Medicine

Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2015

Squamous cell carcinoma at bladder exstrophy site after early cystectomy

Outcome of laparoscopic versus open gastrostomy in children

Rho-kinase expression in Hirschsprung’s disease

Repeat computed tomography scans after pediatric trauma: results of an institutional effort to minimize radiation exposure

Injury patterns and outcomes following pediatric bicycle accidents

A pediatric specific shock index in combination with GMS identifies children with life threatening or severe traumatic brain injury