Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery: prospective randomized controlled trial.
OBJECTIVE
The aim of the study was to determine efficacy of continuous incisional infusion of local anesthetic, ON-Q® pain relief system (Kimberly-Clark, Georgia), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery.


METHODS
Prospective open-labeled randomized controlled trial comparing the ON-Q® pain relief system to standard of care pain management. Pain was assessed by nurses using the Visual Analog Scale or the Face, Legs, Activity, Cry, Consolability Scale depending on the child's age. Information regarding analgesic consumption and recovery parameters such as temperature, start of oral nutrition, and length of hospitalization were prospectively collected.


RESULTS
Patient's demographic, clinical, and surgical characteristics were similar in both groups. The ON-Q® group experienced significantly lower scores of maximal daily pain episodes compared to the control on the day of surgery (1.9±1.8 vs. 4.2±2.2 p=0.009) and first postoperative day (2.28±3.2 vs. 5.47±2.45 p=0.004). Mean number of narcotic doses was significantly lower in treatment group compared to control [Total (2.21 vs. 4.6 p=0.02), POD0 (0.7 vs. 1.7 p=0.02) and POD1 (1.3 vs. 2.8 p=0.04)].


CONCLUSIONS
The ON-Q® system is a viable option for postoperative pain management in children undergoing urological surgeries. This technology significantly decreases the amount of maximal pain, and the need for systemic narcotic consumption.
University of California, Irvine/CHOC Children's Hospital, Urology Center, 505 South Main Street, Suite 100, Orange, CA 92868, USA. Electronic address: guy@hidas.net.
Guy
G
Hidas
University of California, Irvine/CHOC Children's Hospital, Urology Center, 505 South Main Street, Suite 100, Orange, CA 92868, USA. Electronic address: mpribish@uci.edu.
Maryellen S
MS
Kelly
University of California, Irvine/CHOC Children's Hospital, Urology Center, 505 South Main Street, Suite 100, Orange, CA 92868, USA. Electronic address: bselby@uci.edu.
Blake
B
Watts
University of California, Irvine/CHOC Children's Hospital, Department of Anesthesiology and Perioperative Care, 505 South Main Street, Orange, CA 92868, USA. Electronic address: zkain@uci.edu.
Zeev N
ZN
Kain
University of California, Irvine/CHOC Children's Hospital, Urology Center, 505 South Main Street, Suite 100, Orange, CA 92868, USA. Electronic address: aekhoury@uci.edu.
Antoine E
AE
Khoury
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures
D000701:Analgesics, Opioid; D000779:Anesthetics, Local
Continuous incisional infusion of local anesthetic; ON-Q pain relief system; Postoperative pain; Randomized controlled trail