Swenker Dominique J, Dirckx Maaike, Staals Lonneke M
Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.
Department of Anesthesiology, Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands.
Paediatr Neonatal Pain. 2024 Jun 5;6(4):99-110. doi: 10.1002/pne2.12126. eCollection 2024 Dec.
Wound catheter infusion (WCI) with local anesthetics (LA) is a regional anesthesia technique, which has shown to produce effective postoperative analgesia in adults, without any adverse effects on wound healing. To investigate the efficacy and safety of WCI with LA for the treatment of postoperative pain in children, we conducted a systematic review of literature published until 2020. The literature search included articles concerning subcutaneous WCI with LA, in the surgical wound, as treatment of postoperative pain, in children <18 years of age. Exclusion criteria were studies describing peripheral nerve blocks, intercostal, abdominal or thoracic wall blocks and single local anesthetic infiltration of the surgical wound. The articles were appraised for quality and only randomized controlled trials with a Jadad score ≥3 were included for evaluation of results concerning postoperative pain scores and opioid use. All relevant original studies, including observational studies and case reports, were assessed for adverse events and measurements of LA plasma concentrations during WCI. A total of 1907 articles were found, leading to 92 relevant abstracts selected for further review. After exclusion of articles of which full texts could not be retrieved or because of exclusion criteria, 28 articles remained. Thirteen articles described randomized controlled trials, of which 10 were assessed as good or excellent in quality. Due to the small number and heterogeneity of the studies, the data could not be pooled. Instead, results were described per type of procedure: abdominal surgery, extremity surgery, thoracic surgery and iliac crest bone harvesting. Reduced pain scores and opioid needs were demonstrated after abdominal and extremity surgery. In five studies, plasma levels of LA were measured, which all remained below toxic thresholds. In all relevant studies, no serious adverse events concerning the use of WCI were reported.
伤口导管输注（WCI）联合局部麻醉药（LA）是一种区域麻醉技术，已证明可在成人中产生有效的术后镇痛效果，且对伤口愈合无任何不良影响。为研究WCI联合LA治疗儿童术后疼痛的有效性和安全性，我们对截至2020年发表的文献进行了系统综述。文献检索包括有关在18岁以下儿童手术伤口中进行皮下WCI联合LA治疗术后疼痛的文章。排除标准为描述外周神经阻滞、肋间、腹壁或胸壁阻滞以及手术伤口单次局部麻醉药浸润的研究。对文章进行质量评估，仅纳入Jadad评分≥3的随机对照试验，以评估术后疼痛评分和阿片类药物使用结果。对所有相关的原始研究，包括观察性研究和病例报告，评估WCI期间的不良事件和LA血浆浓度测量值。共找到1907篇文章，筛选出92篇相关摘要进行进一步审查。排除无法检索全文或因排除标准而不符合的文章后，剩余28篇文章。13篇文章描述了随机对照试验，其中10篇质量评估为良好或优秀。由于研究数量少且存在异质性，无法合并数据。取而代之的是，按手术类型描述结果：腹部手术、肢体手术、胸外科手术和髂嵴取骨术。腹部和肢体手术后疼痛评分降低，阿片类药物需求减少。在五项研究中测量了LA的血浆水平，均保持在毒性阈值以下。在所有相关研究中，均未报告与使用WCI相关的严重不良事件。
