Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery



      To determine the efficacy of the locally infused anesthetic, ON-Q® pain relief system (Kimberly–Clarke, GA–USA), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery.

      Material and methods

      A case–control analysis comparing 20 patients undergoing major urological procedures who were treated postoperatively with the ON-Q system was compared to 20 patients treated with current hospital standard of care intravenous and oral analgesics. Pain was assessed in both groups by staff nurses using the different validated scales depending on the child's age. Information regarding analgesic consumption along with recovery parameters such as temperature, start of oral nutrition, and length of hospitalization (LOH) were collected.


      The ON-Q group experienced significantly lower ratings of maximal pain on the first postoperative day as compared to the control group (3 vs. 5.2, p = 0.03) and a trend toward lower mean of maximal pain score on postoperative day two (1.8 vs. 3.5, p = 0.055). Systemic intravenous and oral analgesics were significantly lower on the day of surgery and the first postoperative day for the ON-Q group (p = 0.014; and p = 0.046 respectively). No differences in frequency of fever, start of oral nutrition and LOH were found between the study groups.


      Continuous incisional infusion of local anesthetic with the ON-Q system is a viable option for postoperative pain management in children undergoing major urological surgeries. This technology significantly decreases the need for systemic analgesic consumption.



      VAS (visual analog scale), FLACC (Face, Legs, Activity, Cry, Consolability Scale), LOH (length of hospitalization)
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        • Hanna M.N.
        • Murphy J.D.
        • Kumar K.
        • Wu C.L.
        Postoperative pain management in the elderly undergoing thoracic surgery.
        Thorac Surg Clin. 2009; 19: 353-361
        • Partridge B.L.
        • Stabile B.E.
        The effects of incisional bupivacaine on postoperative narcotic requirements, oxygen saturation and length of stay in the post-anesthesia care unit.
        Acta Anaesthesiol Scand. 1990; 34: 486-491
        • Roberge C.W.
        • McEwen M.
        The effects of local anesthetics on postoperative pain.
        AORN J. 1998; 68: 1003-1012
        • Liu S.S.
        • Richman J.M.
        • Thirlby R.C.
        • Wu C.L.
        Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials.
        J Am Coll Surg. 2006; 203: 914-932
        • Ganesh A.
        • Rose J.B.
        • Wells L.
        • Ganley T.
        • Gurnaney H.
        • Maxwell L.G.
        Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children.
        Anesth Analg. 2007; 105: 1234-1242
        • Tirotta C.F.
        • Munro H.M.
        • Salvaggio J.
        • Madril D.
        • Felix D.E.
        • Rusinowski L.
        Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery.
        Paediatr Anaesth. 2009; 19: 571-576
        • Nottingham J.
        • Gregorie D.
        • Zink J.
        Indications and benefits of continuous peripheral local anesthesia.
        J Surg Educ. 2008; 65: 254-258
        • McGrath P.A.
        Pain in the pediatric patient: practical aspects of assessment.
        Pediatr Ann. 1995; 24 (37–8): 126-133
        • DeVita
        • Lawrence Theodore S.
        • Rosenberg Steven A.
        • Weinberg Robert A.
        8th ed. Cancer principle and practice. vol. 2. Lippincott Williams & Wilkins, Philadelphia2008 (p. 2839)