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Local delivery of bupivacaine in the wound reduces opioid requirements after intraabdominal surgery in children
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Surgery.
2013 (English)In: Pediatric surgery international (Print), ISSN 0179-0358, E-ISSN 1437-9813, Vol. 29, no 5, 451-454 p.Article in journal (Refereed) Published
Abstract [en]

Local anaesthetic infusions into the surgical wound have been shown to reduce postoperative pain and the need for opioids in adults. In children, it was found to be safe and efficacious following sternotomy and orthopaedic surgery. The aim of this study was to evaluate the need for opioids postoperatively in children receiving wound catheters delivering either bupivacaine or saline following one of three defined abdominal or bladder procedures. Prospective, randomized, double-blind, placebo controlled study. Thirty-three children, 6 months of age to 13 years of age, undergoing elective surgery for enterostomy closure, open gastrostomy or ureteral reimplantation were randomized to receive bupivacaine or saline wound infusions for 72 h postoperatively. All patients received acetaminophen orally or rectally for every 6 h. Breakthrough pain was treated with morphine bolus doses of 0.05 mg/kg or infusions if more than three morphine doses were required. Pain scores were assessed every 3 h. Outcome measures were morphine dosages, return to full oral intake and length of hospital stay. On the first postoperative day, patients with bupivacaine infusions had significantly less need for morphine (1.3 +/- A 1.3 SD doses) compared to those receiving saline infusions (3.1+/2.5 SD doses, p < 0.05). No difference was seen during postoperative day two or three. There was no significant difference between the groups regarding time to full oral intake and time to discharge. Continuous infusion of bupivacaine in the abdominal wound was effective in reducing postoperative pain in children. It significantly reduced the need for additional opioids and can be considered for postoperative pain management in children.

Place, publisher, year, edition, pages
2013. Vol. 29, no 5, 451-454 p.
Keyword [en]
Pain, Children, Postoperative
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-200344DOI: 10.1007/s00383-013-3296-6ISI: 000317929300007OAI: oai:DiVA.org:uu-200344DiVA: diva2:623625
Available from: 2013-05-28 Created: 2013-05-27 Last updated: 2017-12-06Bibliographically approved

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George, MaryChristofferson, Rolf

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