Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery

Abstract

Spinal deformity corrections in paediatric patients are long-lasting procedures involving damage to many tissues and long pain exposure; therefore, effective pain management after surgical treatment is an important issue. In this study, the effect of inclusion of local infiltration analgesia, as an integral part of the scheme in postoperative pain control, in children and adolescents, subjected to the spinal deformity correction procedure, was assessed. Thirty patients, aged 8 to 17 years, undergoing spinal deformity correction were divided into a study group, receiving a 0.25% bupivacaine solution before wound closure, and a control group (no local analgesic agent). Morphine, at the doses of 0.10 mg/kg of body weight, was administered to the patients when pain occurred. Pain scores, morphine administration, and bleeding were observed during 48 postoperative hours. The pain scores were slightly lower in a 0–4 h period in patients who received bupivacaine compared with those in the control group. However, no differences were observed in a longer period of time and in the total opioid consumption. Moreover, increasing bleeding was observed in the bupivacaine-treated patients (study group) vs. the control. Bupivacaine only modestly affects analgesia and, due to the increased bleeding observed, it should not to be part of pain control management in young patients after spinal deformity correction.

Regional and Local Anesthesia in Pediatric Orthopaedic Surgery

“…43 Spine Surgery Danielewicz et al's prospective cohort study assessed the effect of bupivacaine LIA administration prior to wound closure vs. no LIA in children and adolescents (8-17 years) subjected to spinal deformity correction procedure on postoperative opioid consumption, pain intensity, and bleeding in the early postoperative period. 44 The study group was comprised of 13 females and four males with a mean age of 15.1 (range: 12.6-17.5), and the control group was comprised of 11 females and two males with a mean age of 14 (range: 8.5-17). Pain scores were slightly lower in the 0-4 hours period in LIA patients compared to the control group; however, after this time period no differences were observed.…”

Effectiveness of port site bupivacaine infiltration in postoperative pain reduction after laparoscopic cholecystectomy: A randomized controlled trial from a tertiary care hospital.

“…It may be administered as 0.25 to 0.50% solution in form of direct application prior to wound closure or as a catheter infusion, allowing medication to be released to the wound gradually. 13 Previously available literature studied bupivacaine effects in local infiltration for post-operative pain control in other surgical procedure. 12 However, findings relating to pain relief and analgesic consumption are differing and treatment still needs a complete evaluation.…”