Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review.
IntroductionSystematic 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 MethodsData sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray.


METHODS
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.


METHODS
Independent duplicate data extraction and quality assessment using standardized fields.ResultsThe selection process uncovered three eligible published trials and one unpublished study, all in laparoscopy surgery.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.ConclusionsIPLA 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.
Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand.
James K
JK
Hamill
Department of Surgery, University of Auckland, Auckland, New Zealand.
Jamie-Lee
JL
Rahiri
Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand.
Andrew
A
Liley
Department of Surgery, University of Auckland, Auckland, New Zealand.
Andrew G
AG
Hill
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007274:Injections, Intraperitoneal / Q000379:methods; D010535:Laparoscopy; D010147:Pain Measurement / Q000145:classification*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D010537:Peritoneum / Q000601:surgery; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D000779:Anesthetics, Local