The effect of local anaesthetic on post-operative pain with wound instillation via a catheter for paediatric orthopaedic extremity surgery

Abstract

Purpose We aimed to investigate the effects on postoperative pain of local anaesthetic administration via a catheter placed into the operation site in patients who were undergoing upper and lower extremity paediatric orthopaedic surgery. Methods In this randomised, double-blind and placebo study, 40 ASA I-II patients aged between 1 and 12 years were randomly allocated into two groups: study group (Group S: 0.2 ml/kg, 0.5% bupivacaine, n = 20) and control group (Group C: 0.2 ml/kg, serum physiologic, n = 20). Before the fascia was closed by the surgical team, the solution previously prepared by the chief nurse was injected into the subfascial soft tissue with the syringe as the ''injected dose'' of serum physiologic or bupivacaine. After the closure, 0.2 ml/kg (1 mg/kg) bupivacaine or saline was instillated as the ''first instillated dose'' into the surgical area via the catheter. Pain scores were recorded at 0, 1, 2, 4, 8, 12, 24 and 48 h post-operatively. Patients were administered 0.75 mg/kg meperidine intramuscularly postoperatively to equalise the pain scores.

Plasma concentrations of levobupivacaine associated with two different intermittent wound infusion regimens following surgical ductus ligation in preterm infants

“…An adult meta‐analysis has found that the use of wound catheter techniques is surprisingly effective following thoracic and abdominal procedures and successful use of wound catheter techniques has also recently been reported in children following sternotomy, iliac bone grafting, and minor–moderate abdominal surgery .…”

Polymelia in a chimeric Simmental calf: nociceptive withdrawal reflex, anaesthetic and analgesic management, anatomic and genetic analysis

“…Bupivacaine administered locally provided prolonged desensitization of the damaged tissues, thus preventing local ectopic activity of primary afferents in the immediate post-operative period. In human, pediatric orthopaedic surgery, prolonged bupivacaine instillation via wound catheter in the postoperative period led to lower pain scores and less required additional opioids [25]. Until the day of discharge, the calf showed no signs of pain in the normal limb with exception of the wound area itself which was mildly sensitive to palpation once local anaesthetics were discontinued.…”

Case Report: Ultrasound Guided Peripheral Nerve Blockade Reduces Halothane and Improves Post Operative Analgesia for Paediatric Trauma. A First at Marsabit General Hospital, Kenya

“…Catheters were inserted for thoracic, general and orthopaedic surgical procedures. It has been shown in the literature that catheters inserted for these indications have a positive impact on post operative pain scores [1][2][3][4] . Wound catheters remained in situ for 2.8 days on average.…”