Local Anesthetic Infiltration of the Wound for Postoperative Pain Management in Pediatric Cases

Abstract

Two pediatric patients for whom local anesthetic infiltration of the wound was used for postoperative pain management are reported. Case 1 was an 11-year-old male undergoing pyeloplasty. Surgery was performed by a lumbodorsal approach. During wound closure, an 18-gauge multi-hole catheter was placed on the layer above the transversus abdominis muscle. Postoperatively, 20 ml of ropivacaine 0.375% were administered through the catheter, and continuous infusion of ropivacaine 0.2% at 3 ml/h was performed. As additional analgesia, fentanyl 0.2 μg/kg/h was infused intravenously. Pain scores on the Numerical Rating Scale (NRS) and the Prince Henry Pain Scale (PHPS) were low (NRS: 0-2, PHPS: 1) until the catheter was removed. No side effects were observed. Case 2 was a 2-year-old female with congenital biliary dilatation. Surgery was performed through a right upper quadrant transverse incision. As in case 1, during wound closure, a catheter was placed on the layer under the rectus abdominis muscle. Postoperatively, 5 ml of ropivacaine 0.375% were administered through the catheter, and continuous infusion of ropivacaine 0.2% at 2 ml/h was performed. Fentanyl 0.2 μg/kg/h was infused intravenously. Until the catheter was removed, pain scores were 1 on the FACES Pain Rating Scale. These cases show that this approach can provide pain relief for postoperative pediatric cases.