title: Use of local anesthetic (0.25% bupivacaine) for pain control after pediatric cardiac catheterization: A randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effects of local infiltration of 0.25% bupivacaine on post-operative pain and analgesic use in children undergoing cardiac catheterization procedures.
  
  
  BACKGROUND
  In pediatric catheterization procedures performed under general anesthesia, a local anesthetic is often used prior to femoral sheath removal. There are no published reports of the impact of local anesthetic infiltration on pain after pediatric procedures, and mixed reports on its effectiveness in adults.
  
  
  METHODS
  A randomized controlled trial was undertaken of 140 children, aged 7-18 years undergoing cardiac catheterization under general anesthesia via the femoral vein or artery. Participants received a subcutaneous infiltration of 0.25% bupivacaine at the access site prior to sheath removal, or usual care without bupivacaine. Outcomes included patient reported pain scores and analgesic use up to 6 hr after the procedure.
  
  
  RESULTS
  Pain scores were similar between groups through the 6-hr post-procedure period. The proportion of children reporting a maximal pain score of ≤2/10 was higher in the bupivacaine group (64% vs. 44%, P = 0.03). A significantly higher proportion of children in the control group required IV morphine (18.8% vs. 4.5%, P = 0.02).
  
  
  CONCLUSIONS
  Morphine use can be reduced with the use of 0.25% bupivacaine given prior to femoral sheath removal and should be considered for post-procedural pain control for pediatric patients undergoing cardiac catheterization. This study is the first to contribute evidence to the effectiveness of 0.25% bupivacaine after pediatric cardiac catheterization.
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Palma
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Viegas
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: McCrindle
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic & Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009864:Ontario; D010146:Pain / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D010147:Pain Measurement; D010372:Pediatrics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine
keywords: CATH-catheterization; COMP-complications; CONP-congenital heart disease; VCOM-vascular complications; diagnostic; pediatric catheterization/intervention; pediatrics