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

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  • KIKUCHI TOSHIHIRO
    Department of Anesthesiology and Pain Medicine, Juntendo University Nerima Hospital
  • TANABE YUTAKA
    Department of Anesthesiology and Pain Medicine, Juntendo University Nerima Hospital
  • KUMAKURA SEIICHIRO
    Department of Anesthesiology and Pain Medicine, Juntendo University Nerima Hospital
  • TANAKA HIDEFUMI
    Department of Anesthesiology and Pain Medicine, Juntendo University Nerima Hospital

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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.

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