title: Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  Continuous subfascial bupivacaine infusion is reliable, safe and effective in paediatric post-operative pain control with considerably reduced opiate requirements.
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa. stanmugambi@yahoo.co.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Machoki
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: A J W
authors.initials: AJ
authors.lastname: Millar
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: H
authors.initials: H
authors.lastname: Albetyn
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: S G
authors.initials: SG
authors.lastname: Cox
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Numanoglu
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D015360:Analgesia, Epidural / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001064:Appendicitis / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D009020:Morphine; D002045:Bupivacaine
keywords: Abdominal surgery; Bupivacaine; Children; Local anaesthetic; Paediatric; Postoperative analgesia; Sub-fascial infusion; Wound infusion