ESRA19-0109 The effect of patient controlled local anesthetic wound infusion on postoperative pain in children undergoing laparotomy

Background and aims Local anaesthetic wound infusions have shown promising results in reducing postoperative pain and the need of opioids in adults. But its use in children is still limited. Previously we found this method extremely effective for postoperative pain treatment in children undergoing orthopedic surgery. the aim of this report was to present the effectiveness of patient controlled local anaesthetic wound infusion in children undergoing laparotomy. Methods Two patients in pediatric surgery department underwent laparotomy under general anesthesia and local anesthetic wound infusion was used for postoperative pain management. Catheter was placed into the surgical wound. After the wound closure the PCA pump was connected and delivery of local anesthetic levobupivacaine 0.25% and 1.25 μg/ml of fentanyl solution was started. Pain was evaluated using VAS scores every 3 hours, up to 48 hours when catheter was removed. Results Both patients received single dose of opioids before the end of anesthesia. Also NSAID and acetaminophen was given. Postoperatively both patients received additional treatment with NSAID once per day. VAS scores were 0–4. No complications such as wound infection or systemic toxicity were reported. Conclusions Patient controlled wound infusion with local anesthetics was effective for postoperative pain treatment in pediatric patients undergoing laparotomy. the use of local anesthetics reduced total opioids requirements and improved pain scores. Less opioids requirement was associated with less opioid related side effects, better bowel recovery, shorter length of hospital stay, earlier mobilization. This method could be best choice for postoperative pain treatment in children undergoing open abdominal surgical procedures.