title: Port Site Local Anesthetic Infiltration Vs Single-dose Intrathecal Opioid Injection to Control Perioperative Pain in Children Undergoing Minimal Invasive Surgery: A Comparative Analysis.
abstract: To compare the efficacy of the intrathecal opiate vs wound site local anesthetic infiltration for perioperative pain control during and after surgery in patients undergoing minimally invasive pediatric urologic procedures.
  
  
  
  Using an Institutional Review Board-approved registry database, we identified patients who underwent minimally invasive urologic procedures at our institution between 2009 and 2013. We collected all relevant preoperative variables and postoperative outcomes. Patients in intrathecal injection of opioids (ITO) group were matched with patients who received local anesthetic infiltration (LAI) based on age, diagnosis, and procedure. Perioperative analgesic requirements were converted to morphine equivalents standardized to body weight. Statistical analysis was performed using SPSS, and parametric comparisons were completed to determine difference in morphine equivalents between the 2 groups.
  
  
  
  One hundred thirty children (78 girls and 52 boys) were included in our study. Sixty-six patients underwent ITO and 66 received LAI. Sixty-six patients underwent ureteral reimplantation, 60 underwent pyeloplasty, and 4 underwent nephrectomy. Ages ranged from 0.5 to 19.9 years. There was no significant difference in cumulative morphine equivalents or weight administered between the ITO and LAI groups for the total period of hospitalization (0.76 units vs 0.79 units, P > .05). Multivariate regression analysis predicted that older age corresponds to higher analgesic requirements.
  
  
  
  ITO does not impact total analgesic requirements during the hospital stay compared to LAI following minimally invasive surgery. Considering the potential complications of ITO, LAI may be the preferred modality for pain management for minimally invasive surgery in children.
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: srinivasana3@email.chop.edu.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srinivasan
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Dhiren
authors.initials: D
authors.lastname: Shrivastava
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Kurzweil
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Weiss
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Long
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Aseem R
authors.initials: AR
authors.lastname: Shukla
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D007668:Kidney / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D059035:Perioperative Period; D012092:Replantation; D065287:Robotic Surgical Procedures; D014513:Ureter / Q000601:surgery; D013520:Urologic Surgical Procedures; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal