title: Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery.
abstract: OBJECTIVE
  To determine the efficacy of the locally infused anesthetic, ON-Q(®) pain relief system (Kimberly-Clarke, GA-USA), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery.
  
  
  METHODS
  A case-control analysis comparing 20 patients undergoing major urological procedures who were treated postoperatively with the ON-Q system was compared to 20 patients treated with current hospital standard of care intravenous and oral analgesics. Pain was assessed in both groups by staff nurses using the different validated scales depending on the child's age. Information regarding analgesic consumption along with recovery parameters such as temperature, start of oral nutrition, and length of hospitalization (LOH) were collected.
  
  
  RESULTS
  The ON-Q group experienced significantly lower ratings of maximal pain on the first postoperative day as compared to the control group (3 vs. 5.2, p = 0.03) and a trend toward lower mean of maximal pain score on postoperative day two (1.8 vs. 3.5, p = 0.055). Systemic intravenous and oral analgesics were significantly lower on the day of surgery and the first postoperative day for the ON-Q group (p = 0.014; and p = 0.046 respectively). No differences in frequency of fever, start of oral nutrition and LOH were found between the study groups.
  
  
  CONCLUSIONS
  Continuous incisional infusion of local anesthetic with the ON-Q system is a viable option for postoperative pain management in children undergoing major urological surgeries. This technology significantly decreases the need for systemic analgesic consumption.
authors.affiliation: Department of Urology, University of California, Irvine, Children's Hospital of Orange County, Orange, CA, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Hidas
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Blake
authors.initials: B
authors.lastname: Watts
authors.forename: Maryellen
authors.initials: M
authors.lastname: Pribish
authors.forename: Edwin T
authors.initials: ET
authors.lastname: Tan
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Antoine
authors.initials: A
authors.lastname: Khoury
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007260:Infusion Pumps; D008297:Male; D009043:Motor Activity; D009294:Narcotics / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D009294:Narcotics
keywords: Continuous incisional infusion of local anesthetic; FLACC; Face, Legs, Activity, Cry, Consolability Scale; LOH; ON-Q pain relief system; Postoperative pain; VAS; length of hospitalization; visual analog scale