Continuous local anesthetic infusion for children with spina bifida undergoing major reconstruction of the lower urinary tract

Summary Objective While many options for postoperative analgesia are available to the general patient population, choices are limited for individuals with spinal dysraphism. We hypothesized that the use of continuous local anesthetic infusion following major reconstruction of the lower urinary tract...

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Bibliographic Details
Published in:Journal of pediatric urology 2015-04, Vol.11 (2), p.72.e1-72.e5
Main Authors: Chalmers, D.J, Bielsky, A, Wild, T.T, Siparsky, G.L, Wilcox, D.T
Format: Article
Language:English
Subjects:
Analgesics, Opioid - administration & dosage
Anesthetics, Local - administration & dosage
Bladder augmentation
Child
Cohort Studies
Continuous local anesthetic infusion
Enhanced recovery after surgery
Female
Follow-Up Studies
Humans
Infusion Pumps, Implantable
Infusions, Intravenous
Male
Pain Measurement
Pain, Postoperative - diagnosis
Pain, Postoperative - drug therapy
Pediatrics
Retrospective Studies
Risk Assessment
Spina bifida
Spinal Dysraphism - complications
Spinal Dysraphism - diagnosis
Statistics, Nonparametric
Treatment Outcome
Urinary Bladder, Neurogenic - etiology
Urinary Bladder, Neurogenic - physiopathology
Urinary Bladder, Neurogenic - surgery
Urologic Surgical Procedures - adverse effects
Urologic Surgical Procedures - methods
Urology
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Summary:Summary Objective While many options for postoperative analgesia are available to the general patient population, choices are limited for individuals with spinal dysraphism. We hypothesized that the use of continuous local anesthetic infusion following major reconstruction of the lower urinary tract in children with spina bifida would significantly decrease need for opiate use, while maintaining adequate pain control. Materials and methods Children with spina bifida who underwent major reconstruction of the lower urinary tract at Children's Hospital Colorado were identified from January, 2003 through January, 2013 were identified. In addition to enterocycstoplasty, procedures included Mitrofanoff or Monti creation, bladder neck reconstruction, and Malone antegrade continence enema. Patients who had local anesthetic infusion catheters placed in the incision were compared to patients without catheters. Opioid consumption was calculated by conversion of any opiates into IV morphine (mg/kg) on postoperative days (POD) 0–3. Pain was assessed by mean and maximum FLACC scores on POD 0–2. Use of antiemetic medications and wound related complications were recorded as secondary metrics. Patients with other etiologies for neurogenic bladder and bowel were excluded. Patients whose pain was assessed by other assessment scales were excluded. Chi-squared analysis was used for nominal variables, students t-test was used for analysis of continuous variables. P values
ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2014.10.011