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

Purpose: The aim of the study was to determine efficacy of continuous incisional infusion of local anesthetic, ON-Q (R) pain relief system (Kimberly-Clark, Georgia), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery. Material and methods: Prospective open-labeled randomized controlled trial comparing the ON-Q (R) pain relief system to standard of care pain management. Pain was assessed by nurses using the Visual Analog Scale or the Face, Legs, Activity, Cry, Consolability Scale depending on the child's age. Information regarding analgesic consumption and recovery parameters such as temperature, start of oral nutrition, and length of hospitalization were prospectively collected. Results: Patient's demographic, clinical, and surgical characteristics were similar in both groups. The ON-Q (R) group experienced significantly lower scores of maximal daily pain episodes compared to the control on the day of surgery (1.9 +/- 1.8 vs. 4.2 +/- 2.2 p=0.009) and first postoperative day (2.28 +/- 3.2 vs. 5.47 +/- 2.45 p=0.004). Mean number of narcotic doses was significantly lower in treatment group compared to control [Total (2.21 vs. 4.6 p=0.02), POD0 (0.7 vs. 1.7 p=0.02) and POD1 (1.3 vs. 2.8 p=0.04)]. Conclusion: The ON-Q (R) system is a viable option for postoperative pain management in children undergoing urological surgeries. This technology significantly decreases the amount of maximal pain, and the need for systemic narcotic consumption. (C) 2015 Elsevier Inc. All rights reserved.