Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery

Tirotta, Christopher F.; Munro, Hamish M.; Salvaggio, Jane; Madril, Danielle; Felix, Donald E.; Rusinowski, Lynda; Tyler, Cristi; DeCampli, William M.; Hannan, Robert L.; Burke, Redmond P.

doi:10.1111/j.1460-9592.2009.03009.x

Cited by 60 publications

(40 citation statements)

References 17 publications

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“…Our results support the conclusions from our retrospective study that the ON-Q® pump significantly decreases the need for systemic analgesic consumption [8]. Our results also support the prospective randomized double-blind study of Tirotta et al [6], which concluded that the continuous infusion of local anesthesia can reduce the postoperative narcotic and sedative requirements, and allow earlier return of bowel function in pediatric patients undergoing a median sternotomy incision. Our study indicates and supports the idea that site-specific continuous analgesia is a viable approach to postoperative pain management.…”

Section: Discussionsupporting

confidence: 93%

“…Unfortunately, the analgesic duration of most local anesthetics administrated intraoperatively is short, and therefore continuous infusion has been suggested to increase its duration of effect. Continuous infusion of site-specific analgesia results in fewer side effects and better postoperative recovery as assessed by earlier mobilization and earlier discharge [4][5][6][7]. One device that currently provides continuous infusion of analgesia is the ON-Q® pump (Kimberly-Clark, Georgia) (Fig.…”

mentioning

confidence: 99%

“…There are currently only two previous pediatric studies of the ON-Q® pump system, which focused only on cardiac surgery with a sternotomy incision [5] and various orthopedic procedures [6].…”

mentioning

confidence: 99%

“…This device is an elastomeric pump that delivers 0.25% bupivacaine at the incision site via a flexible silver-coated catheter that is tunneled subcutaneously at the completion of a patient's surgery. The catheter is attached to the elastomeric pump, which has a flow-limiting valve [6,7]. The local anesthetic is delivered at a constant flow rate for the entire duration of use that is predetermined according to the patient's weight.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

Hidas

Kelly

Watts

et al. 2015

Journal of Pediatric Surgery

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Hidas

Kelly

Watts

et al. 2015

Journal of Pediatric Surgery

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“…In children undergoing heart surgery, Tirotta et al compared the analgesic efficacy of subcutaneous 0.25% levobupivacaine infusion and saline (controls) through a single catheter tunneled parallel to the sternal wound. They showed the group with the local anesthetic infusion required less morphine over the first 24 hours and required less sedatives over 72 hours.…”

Section: Continuous Local Anesthetic Wound Infusionmentioning

confidence: 99%

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Raj

2019

Pediatric Anesthesia

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Summary Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid‐related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound‐guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.

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Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer

Gostian

Loeser

Albert

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Up to 80% of patients with head and neck cancer undergoing ablative surgery and neck dissection develop postoperative pain with detrimental effects on quality of life that also contributes to neuropathic and chronic postoperative pain.OBJECTIVE To investigate the association of continuous local anesthetic wound infusion with pain management after head and neck surgery.DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal, nonrandomized clinical study carried out in a single tertiary referral center (December 1, 2015, to July 1, 2017) included 2 groups of 30 patients. Patients were consecutively enrolled and presented for ablative head and neck surgery including selective neck dissection and studied from the preoperative through the fourth postoperative day. INTERVENTIONSThe control group was treated according to a standardized escalating oral treatment protocol (ibuprofen, metamizole, opioids). The intervention group was treated with an intraoperatively applied pain catheter (InfiltraLong plus FuserPump, Pajunk, ropivacaine, 0.2%, 3 mL/h) that was removed 72 hours after operating. MAIN OUTCOMES AND MEASURESAverage and maximum pain intensities on a numeric rating scale; quality of life using the acute version of the validated 36-Item Short Form Survey; and neuropathic pain using the validated 12-Item painDETECT questionnaire. Consumption of opioid and nonopioid analgesics and evaluation of catheter-associated complications. RESULTS Duringpostoperative days 1 through 4, patients of the intervention group (mean [SD] age, 63.2 [13.3 years; 9 [30%] women) experienced lower mean (SD) (1.6 [1.4] vs 2.7 [1.8]; η 2 p = 0.09 [0.01-0.21]) and maximum (2.4 [2.2] vs 4.2 [2.0]; η 2 p = 0.11 [0.01-0.24]) pain intensities compared with the control group (mean [SD] age, 62.5 [13.6] years; 5 [17%]women). The intervention group also reported less neuropathic pain (mean [SD], 5.4 [3.4] vs 7.6 [5.1]; η 2 p = 0.09 [0.004 -0.22]) and higher quality of life regarding vitality (56.2 [21.5] vs 43.8 [20.9], r = 0.29; 95% CI, 0.01-0.52) and pain (66.8 [27.3] vs 49.5 [27.7], r = 0.31; 95% CI, 0.04-0.54). Patients from the intervention group requested nonopioid analgesics considerably less often (n = 17 [57% ]vs n = 29 [97%]; = 0.47; 95% CI, 0.30-0.67) associated with a noticeably lower need to escalate pain treatment (n = 3 [10%] vs n = 9 [30%]; mean [SD] ibuprofen dose: 500 [173] mg vs 1133 [650] mg; r = 0.64; 95% CI, 0.02-0.91). No catheter-associated complications were observed.CONCLUSIONS AND RELEVANCE Continuous anesthetic wound infusion is associated with reduced postoperative pain and decreased demand for analgesics. It therefore expands the treatment options for postoperative pain in head and neck cancer.

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Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery

Cited by 60 publications

References 17 publications

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

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

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer

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