Eur J Pediatr Surg 2016; 26(06): 469-475
DOI: 10.1055/s-0036-1582243
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review

James K. Hamill
1   Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand
,
Jamie-Lee Rahiri
2   Department of Surgery, University of Auckland, Auckland, New Zealand
,
Andrew Liley
3   Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
,
Andrew G. Hill
2   Department of Surgery, University of Auckland, Auckland, New Zealand
› Author Affiliations
Further Information

Publication History

05 January 2016

26 February 2016

Publication Date:
22 April 2016 (online)

Abstract

Introduction Systematic reviews report intraperitoneal local anesthetic (IPLA) effective in adults but until now no review has addressed IPLA in children. The objective of this review was to answer the question, does IPLA compared with control reduce pain after pediatric abdominal surgery.

Materials and Methods Data sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray. Study selection: Independent duplicate searching for randomized controlled trials of IPLA versus no IPLA/placebo in children ≤ 18 years of age, reporting pain, or opioid use outcomes. Data extraction: Independent duplicate data extraction and quality assessment using standardized fields.

Results The selection process uncovered three eligible published trials and one unpublished study, all in laparoscopy surgery. Qualitative synthesis suggested that IPLA may reduce pain scores, opioid use, time to first opioid, and the need for rescue analgesia, with no effect on hospital stay. Risk of bias was significant.

Conclusions IPLA appears promising in pediatric surgery. The high absorptive capacity of the peritoneum and high peritoneal surface area to volume ratio in children presents a dose limitation. In comparison to adult surgery, IPLA has been understudied in pediatric surgery.

 
  • References

  • 1 Tomecka MJ, Bortsov AV, Miller NR , et al. Substantial postoperative pain is common among children undergoing laparoscopic appendectomy. Paediatr Anaesth 2012; 22 (2) 130-135
  • 2 Russell P, von Ungern-Sternberg BS, Schug SA. Perioperative analgesia in pediatric surgery. Curr Opin Anaesthesiol 2013; 26 (4) 420-427
  • 3 DiZerega GS, Rodgers KE. The peritoneum. New York, NY: Springer-Verlag; 1992: 1-378
  • 4 Hanson IR, Hingson RA. The use of xylocaine, a new local anesthetic, in surgery, obstetrics and therapeutics. A preliminary report. Anesth Analg 1950; 29: 136-147
  • 5 Kahokehr A, Sammour T, Srinivasa S, Hill AG. Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg 2011; 98 (1) 29-36
  • 6 Kahokehr A, Sammour T, Zargar Shoshtari K, Taylor M, Hill AG. Intraperitoneal local anesthetic improves recovery after colon resection: a double-blinded randomized controlled trial. Ann Surg 2011; 254 (1) 28-38
  • 7 Gurusamy KS, Nagendran M, Guerrini GP, Toon CD, Zinnuroglu M, Davidson BR. Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014; 3: CD007337
  • 8 Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci 2010; 17 (5) 637-656
  • 9 Khoo AK, Cartwright R, Berry S, Davenport M. Cholecystectomy in English children: evidence of an epidemic (1997-2012). J Pediatr Surg 2014; 49 (2) 284-288, discussion 288
  • 10 Witt WP, Weiss AJ, Elixhauser A. Overview of Hospital Stays for Children in the United States, 2012. HCUP Statistical Brief #187. Rockville, MD: Agency for Healthcare Research and Quality; 2014
  • 11 Moher D, Liberati A, Tetzlaff J, Altman DG ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (4) 264-269, W64
  • 12 Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011). London, United Kingdom: The Cochrane Collaboration; 2011. Available at: www.handbook.cochrane.org . Accessed March 31, 2016
  • 13 Di Pace MR, Cimador M, Catalano P , et al. Efficacy of periportal infiltration and intraperitoneal instillation of ropivacaine after laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 2009; 19 (6) 821-825
  • 14 El Basha S, Hanna MG, Soaida SM, Refaee HH. Intraperitoneal instillation of l-bupivacaine in laparoscopic pediatric procedures: a randomized-controlled study. Ain-Shams J Anaesthesiol 2015; 8 (2) 247-251
  • 15 Galante D, Pedrotti D. Postoperative pain management through intraperitoneally local anesthetic in pediatric patients hospitalized in picu after laparoscopic surgery. Pediatric Critical Care Medicine 2014; 15 (4) 74
  • 16 Galante D. The laparoscopic oncologic surgical pathology and postoperative pain management through intraperi- toneally local anesthetic in pediatric patients. Pediatr Blood Cancer 2014; 61: S243-S244
  • 17 Hamill J, Rahiri J-L, Hill A. Intraperitoneal local anaesthetic in paediatric surgery. PROSPERO 2015:CRD42015025862. Available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025862 . Accessed March 31, 2016
  • 18 Freilich DA, Houck CS, Meier PM, Passerotti CC, Retik AB, Nguyen HT. The effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children undergoing robotic-assisted laparoscopic pyeloplasty. J Pediatr Urol 2008; 4 (5) 337-340
  • 19 Zanetta VC, Meier-Haran P, Houck CS, Pereira LM, Nguyen HT, Cilento BG. The use of intraperitoneal nebulization of bupivacaine reduces the need for postoperative opioids in young children undergoing robotic-assisted laparoscopic reconstructive surgery. J Urol 2012; 187 (4) e298
  • 20 Haller A. Primae linae physiologiae in usum Praelectionum Academicarum avetae et emendato. Gottingae: Capit25; 1751: 421
  • 21 Robinson B. The Peritoneum. Part 1, Histology and Physiology. Chicago: W.T. Keener; 1897: 255-277
  • 22 Catterall WA. A 3D view of sodium channels. Nature 2001; 409 (6823) 988-989, 991
  • 23 Scholz A. Mechanisms of (local) anaesthetics on voltage-gated sodium and other ion channels. Br J Anaesth 2002; 89 (1) 52-61
  • 24 Albanese AM, Albanese EF, Miño JH , et al. Peritoneal surface area: measurements of 40 structures covered by peritoneum: correlation between total peritoneal surface area and the surface calculated by formulas. Surg Radiol Anat 2009; 31 (5) 369-377
  • 25 Fuhrer Y, Charpentier C, Boulanger G, Menu N, Grosdidier G, Laxenaire MC. Analgesia after laparoscopic cholecystectomy by intraperitoneal administration of bupivacaine [in French]. Ann Fr Anesth Reanim 1996; 15 (2) 128-134
  • 26 Kahokehr A, Sammour T, Vather R, Taylor M, Stapelberg F, Hill AG. Systemic levels of local anaesthetic after intra-peritoneal application—a systematic review. Anaesth Intensive Care 2010; 38 (4) 623-638
  • 27 De Clive-Lowe SG, Gray PWS, North J. Succinyldicholine and lignocaine by continuous intravenous drip; report of 1000 administrations. Anaesthesia 1954; 9 (2) 96-104
  • 28 Hollmann MW, Strümper D, Durieux ME. The poor man's epidural: systemic local anesthetics for improving postoperative outcomes. Med Hypotheses 2004; 63 (3) 386-389
  • 29 Hollmann MW, Wieczorek KS, Berger A, Durieux ME. Local anesthetic inhibition of G protein-coupled receptor signaling by interference with Galpha(q) protein function. Mol Pharmacol 2001; 59 (2) 294-301
  • 30 Makdessi MJ, Barr TP, Xue W, Strichartz GR. Bupivacaine inhibits endothelin-1-evoked increases in intracellular calcium in model sensory neurons. Acta Anaesthesiol Scand 2015; 59 (7) 936-945
  • 31 Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication?. Anesthesiology 2000; 93 (3) 858-875
  • 32 Herroeder S, Pecher S, Schönherr ME , et al. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 2007; 246 (2) 192-200
  • 33 Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 2008; 95 (11) 1331-1338
  • 34 Kuo CP, Jao SW, Chen KM , et al. Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery. Br J Anaesth 2006; 97 (5) 640-646
  • 35 Donatsky AM, Bjerrum F, Gögenur I. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surg Endosc 2013; 27 (7) 2283-2292
  • 36 Ryan GB, Grobéty J, Majno G. Mesothelial injury and recovery. Am J Pathol 1973; 71 (1) 93-112
  • 37 Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal local anaesthetic in abdominal surgery - a systematic review. ANZ J Surg 2011; 81 (4) 237-245
  • 38 Kahokehr A. The effect of intraperitoneal local anaesthetic in colonic surgery [PhD thesis]. Auckland, New Zealand: University of Auckland; 2010
  • 39 Kahokehr A, Sammour T, Srinivasa S, Hill AG. Metabolic response to abdominal surgery: the 2-wound model. Surgery 2011; 149 (3) 301-304
  • 40 Crile GW. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet 1913; 182: 7-16
  • 41 Crile GW, Lower WE, Rowland AF. Anoci-association. Philadelphia, PA: W. B. Saunders Company; 1914: 19-259
  • 42 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78 (5) 606-617
  • 43 Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008; 248 (2) 189-198
  • 44 Ezeh UO, Shoulder VS, Martin JL, Breeson AJ, Lamb MD, Vellacott ID. Local anaesthetic on Filshie clips for pain relief after tubal sterilisation: a randomised double-blind controlled trial. Lancet 1995; 346 (8967) 82-85
  • 45 Hewitt EA, Armstrong G, Beg N, Katz S, Vancaillie TG. Lignocaine plasma levels following topical gel application in laparoscopic and hysteroscopic procedures. Anaesth Intensive Care 2012; 40 (2) 292-296
  • 46 Gurusamy KS, Nagendran M, Toon CD, Guerrini GP, Zinnuroglu M, Davidson BR. Methods of intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014; 3: CD009060
  • 47 Odedra D, Lyons G. Local anaesthetic toxicity. Curr Anaesth Crit Care 2010; 21: 52-54
  • 48 Kolsi K, Ghozzi H, Masmoudi A , et al. Intraperitoneal lignocaine for analgesia after laparoscopic cholecystectomy. Acute Pain 2000; 3: 200-205
  • 49 Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 2002; 94 (1) 100-105
  • 50 Esperanca MJ, Collins DL. Peritoneal dialysis efficiency in relation to body weight. J Pediatr Surg 1966; 1: 162-169
  • 51 Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G. A Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations: To Whom It May Concern. Reg Anesth Pain Med 2015; 40 (6) 698-705
  • 52 Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78 (5) 507-514
  • 53 Karadeniz U, Erdemli O, Unver S, Yasitli H, Ayoglu H. Intraperitoneal bupivacaine infusion and injection for postoperative pain management in laparoscopic cholecystectomy. Anestezi Dergisi 2003; 11: 226-230
  • 54 Hamill JK, Rahiri JL, Liley A, Hill AG. Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials. Paediatr Anaesth 2016; (e-pub ahead of print). doi:10.1111/pan.12855