Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery: Prospective randomized controlled trial

Hidas, Guy; Kelly, Maryellen S.; Watts, Blake; Kain, Zeev N.; Khoury, Antoine E.

doi:10.1016/j.jpedsurg.2014.07.015

Cited by 8 publications

(1 citation statement)

References 9 publications

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“…Effective communication between surgeons and anesthesia clinicians will ensure appropriate patient selection. Reviewed literature endorses regional anesthetic techniques, including peripheral and neuraxial nerve blocks, to decrease opioid requirements for various pediatric surgical specialties, including orthopedics, otolaryngology, urology, plastic surgery, ophthalmology, and general surgery . The heterogeneity of the literature did not allow for definitive recommendations for specific surgical procedures but did illustrate overall effectiveness of regional techniques to minimize opioid use.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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The efficacy of wound catheter infusion with local anesthetics for the treatment of postoperative pain in children: A systematic review

Swenker,

Dirckx,

Staals

2024

Paediatric and Neonatal Pain

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Wound catheter infusion (WCI) with local anesthetics (LA) is a regional anesthesia technique, which has shown to produce effective postoperative analgesia in adults, without any adverse effects on wound healing. To investigate the efficacy and safety of WCI with LA for the treatment of postoperative pain in children, we conducted a systematic review of literature published until 2020. The literature search included articles concerning subcutaneous WCI with LA, in the surgical wound, as treatment of postoperative pain, in children <18 years of age. Exclusion criteria were studies describing peripheral nerve blocks, intercostal, abdominal or thoracic wall blocks and single local anesthetic infiltration of the surgical wound. The articles were appraised for quality and only randomized controlled trials with a Jadad score ≥3 were included for evaluation of results concerning postoperative pain scores and opioid use. All relevant original studies, including observational studies and case reports, were assessed for adverse events and measurements of LA plasma concentrations during WCI. A total of 1907 articles were found, leading to 92 relevant abstracts selected for further review. After exclusion of articles of which full texts could not be retrieved or because of exclusion criteria, 28 articles remained. Thirteen articles described randomized controlled trials, of which 10 were assessed as good or excellent in quality. Due to the small number and heterogeneity of the studies, the data could not be pooled. Instead, results were described per type of procedure: abdominal surgery, extremity surgery, thoracic surgery and iliac crest bone harvesting. Reduced pain scores and opioid needs were demonstrated after abdominal and extremity surgery. In five studies, plasma levels of LA were measured, which all remained below toxic thresholds. In all relevant studies, no serious adverse events concerning the use of WCI were reported.

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Pain Management in Paediatric Urology

Morgan

2020

Practical Pediatric Urology

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Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery: Prospective randomized controlled trial

Cited by 8 publications

References 9 publications

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

The efficacy of wound catheter infusion with local anesthetics for the treatment of postoperative pain in children: A systematic review

Pain Management in Paediatric Urology

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