CLIs were a helpful adjuvant in the four cases presented and may be an effective therapy for a more diverse array of refractory cancer pain. The majority of patients experienced pain relief well beyond the metabolic elimination of the lidocaine, corroborating a modulation effect on pain windup. Additional research regarding infusion rates, serum concentrations, side effects, and outpatient follow-up in a larger group of patients will provide additional insight into the role and safety of this therapy in children.

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BACKGROUND When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the post anesthesia care unit. METHODS A prospective, observational, study of 771 children aged 4–17 years who underwent elective outpatient surgery. Racial differences in probability of receiving analgesia for pain in the recovery room were assessed using bivariable and multivariable logistic regression analyses. RESULTS A total of 294 children (38.2%) received at least one class of analgesia (opioid or non-opioid); while 210 (27.2%) received intravenous opioid analgesia in the recovery room. Overall post anesthesia care unit analgesia utilization was similar between white and minority children (whites 36.8% vs. minority children 43.4%, OR 1.3; 95% CI = 0.92–1.89; p=0.134). We found no significant difference by racial/ethnic group in the likelihood of a child receiving intravenous opioid for severe postoperative pain (whites 76.0% vs. 85.7%, OR 1.89; 95% CI = 0.37–9.67; p=0.437). However, minority children were more likely to receive intravenous opioid analgesia than their white peers (whites 24.5% vs. minority children 34.2%, OR 1.5; 95% CI = 1.04–2.2; p=0.03). On multivariable analysis, minority children had a 63% higher adjusted odds of receiving intravenous opioids in the recovery room (OR =1.63; 95% CI, 1.05–2.62; p=0.03). CONCLUSIONS Receipt of analgesia for acute postoperative pain was not significantly associated with a child’s race. Minority children were more likely to receive IV opioids for the management of mild pain.

BACKGROUND: Transporting patients under anesthesia care incurs numerous potential risks, especially for those with critical illness. The purpose of this study is to identify and report all pediatric anesthesia transport-associated adverse events from a preexisting database of perioperative adverse events. METHODS: An extract of the Wake Up Safe database was obtained on December 14, 2017, and screened for anesthesia transport-associated complications. This was defined as events occurring during or immediately after transport or movement of a pediatric patient during or in proximity to their care by anesthesiologists, including repositioning and transfer to recovery or an inpatient unit, if the cause was noted to be associated with anesthesia or handover. Events were excluded if the narrative clearly states that an event was ongoing and not impacted by anesthesia transport, such as a patient who develops cardiac arrest that then requires emergent transfer to the operating room. The search methodology included specific existing data elements that indicate transport of the patient, handover or intensive care status preoperatively as well as a free-text search of the narrative for fragments of words indicating movement. Screened events were reviewed by 3 anesthesiologists for inclusion, and all data elements were extracted for analysis. RESULTS: Of 2971 events in the database extract, 63.8% met screening criteria and 5.0% (148 events) were related to transport. Events were primarily respiratory in nature. Nearly 40% of all reported events occurred in infants age ≤6 months. A total of 59.7% of events were at least somewhat preventable and 36.4% were associated with patient harm, usually temporary. Of the 86 reported cardiac arrests, 50 (58.1%) had respiratory causes, of which 74% related to anesthesia or perioperative team factors. Respiratory events occurred at all stages of care, with 21.4% during preoperative transport and 75.5% postoperatively. Ninety-three percent of unplanned extubations occurred in patients 6 months and younger. Ten medication events were noted, 2 of which resulted in cardiac arrest. Root causes in all events related primarily to provider and patient factors, with occasional references to verbal miscommunication. CONCLUSIONS: Five percent of reported pediatric anesthesia adverse events are associated with transport. Learning points highlight the risk of emergence from anesthesia during transport to recovery or intensive care unit (ICU). ICU patients undergoing anesthesia transport face risks relating to transitions in providers, equipment, sedation, and physical positioning. Sedation and neuromuscular blockade may be necessary for transport in some patients but has been associated with adverse events in others.

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