Infused anesthetic reduces post-op pain in children

Researchers have identified a new technique that they say will significantly decrease pain for children following high-risk urologic surgeries.

Findings of the technique using locally infused anesthetic were published in the Journal of Pediatric Urology (2013; 9:927-31) by pediatric urologists at Children’s Hospital of Orange County, Orange CA.

“While pain management is a fundamental part of pediatric surgical recovery and care for pediatric patients, current options involve strong prescription painkillers that can put patients at risk for adverse side effects and possible complications,” said study co-author Antoine E. Khoury, MD. “This study demonstrates a major advancement in pain management for pediatric urology patients, significantly reducing postoperative pain and the need for pain medicine.”

The research team evaluated continuous infusion of local anesthesia using the ON-Q pain relief system (Kimberly-Clark, Roswell, GA) to improve pain control in children undergoing urologic procedures. While the pain relief system is well established as an effective pain management technique for adults, researchers say this is the first study that evaluates its effectiveness in children.

Study results found that the ON-Q system decreased the amount of pain experienced by children on the first and second postoperative days, and that it significantly reduced the need for narcotics. During the study, nurses assessed patients’ pain using a visual analog scale and the Face, Legs, Activity, Cry, Consolability Scale, depending on the child’s age, for both the test group and a control group, which received standard-of-care pain management.

The pump delivers the anesthetic in an automatic continuous drip, alleviating concerns about adjusting the dosage. It is also contained in a pouch, so pediatric patients are able to move freely as they recover.

Researchers say additional clinical studies are recommended to further validate this technique as a superior option for postoperative pain management in children undergoing surgery.

In other pediatric urology news, scans using optical projection tomography and contrast-enhanced microCT provided clear pictures of the anatomy of the lower urinary tract and urethra that researchers say will be invaluable when diagnosing lower urinary tract obstruction (LUTO) in utero.

Researchers from Seattle Children’s Hospital used the two forms of imaging to study 10 specimens collected at autopsy from male fetuses with LUTO. Conventional light microscopy was used to verify the findings of each scan. The results were then compared with nine age-matched controls without LUTO. The scans showed more of the lower urinary tract and urethra than previous techniques, and the blockages that caused fetal mortality were clearer than on a regular fetal ultrasound performed in utero, study authors reported in Pediatric and Developmental Pathology (2013; 16:405-14).

Optical projection tomography and microCT offered a clearer, more complete image of obstructions without dissecting organs, researchers reported.

The imaging technology is currently available for use in the research setting.

Kiimberly-Clark provided the ON-Q devices free of charge to study patients.

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