Nitsche Lindsay J, Devlin Paul J, Bond Sarah J, Friedman Jeremy A, Rubnitz Kaitlyn R, Schwartz Emily, Bontrager Colleen E, Karel Lauren I, Nicolson Susan C, Fuller Stephanie M
Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Division of Cardiothoracic Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
JTCVS Open. 2024 Dec 4;23:245-255. doi: 10.1016/j.xjon.2024.11.013. eCollection 2025 Feb.
Bupivacaine liposomal injectable suspension is proven safe and effective for selective postsurgical analgesia in children older than 6 years. We evaluated if intraoperative bupivacaine liposomal injectable suspension administration decreases postoperative opioid use, peak pain scores, and length of stay in children aged 2 to 6 years undergoing cardiac surgery via median sternotomy.
Serial patients aged 2 to 6 years undergoing cardiac surgery received 4 mg/kg bupivacaine liposomal injectable suspension mixed with 0.25% bupivacaine hydrochloride and 0.9% sodium chloride via local infiltration at the conclusion of their procedure. They were matched with controls who underwent operation within the past 5 years by procedure, age, gender, and weight. Postoperative opioid use was converted into morphine milligram equivalents, and pain severity was measured using the Face, Legs, Activity, Cry, and Consolability scale. Paired tests, chi-square tests, and descriptive statistics were used depending on the nature of the data.
A total of 100 patients receiving bupivacaine liposomal injectable suspension and matching historical control patients aged 2 to 6 years were analyzed. There were no significant differences in preoperative variables. Patients receiving bupivacaine liposomal injectable suspension received an average of 3.6 (95% CI, 1.2-6.0) fewer morphine milligram equivalents ( = .003). However, there was no significant difference in peak pain score ( = .4), time to first enteral intake ( = .5), intensive care unit length of stay ( = 1), or hospital length of stay ( = .2). The median cost of bupivacaine liposomal injectable suspension was higher than that of bupivacaine hydrochloride ( < .001).
Intraoperative bupivacaine liposomal injectable suspension use in children aged 2 to 6 years undergoing cardiac surgery showed statistically but not clinically significant decreases in postoperative opioid use. Bupivacaine liposomal injectable suspension use had no impact on intensive care unit or hospital length of stay but was substantially more expensive.
已证实脂质体布比卡因注射用混悬液对6岁以上儿童选择性术后镇痛安全有效。我们评估了在接受正中胸骨切开术的2至6岁心脏手术患儿中，术中给予脂质体布比卡因注射用混悬液是否能减少术后阿片类药物使用、疼痛峰值评分及住院时间。
连续纳入的2至6岁接受心脏手术的患儿在手术结束时通过局部浸润接受4mg/kg脂质体布比卡因注射用混悬液与0.25%盐酸布比卡因和0.9%氯化钠的混合液。将他们与过去5年内接受相同手术、年龄、性别和体重匹配的对照组患儿进行配对。术后阿片类药物使用量换算为吗啡毫克当量，疼痛严重程度采用面部、腿部、活动、哭闹和可安抚性量表进行测量。根据数据性质使用配对t检验、卡方检验和描述性统计。
共分析了100例接受脂质体布比卡因注射用混悬液的患儿及年龄匹配的历史对照患儿（2至6岁）。术前变量无显著差异。接受脂质体布比卡因注射用混悬液的患儿平均吗啡毫克当量减少3.6（95%CI，1.2 - 6.0）（P = 0.003）。然而，疼痛峰值评分（P = 0.4）、首次肠内摄入时间（P = 0.5）、重症监护病房住院时间（P = 1）或住院时间（P = 0.2）无显著差异。脂质体布比卡因注射用混悬液的中位成本高于盐酸布比卡因（P < 0.001）。
在接受心脏手术的2至6岁患儿中，术中使用脂质体布比卡因注射用混悬液术后阿片类药物使用量有统计学意义的减少，但临床意义不显著。使用脂质体布比卡因注射用混悬液对重症监护病房或住院时间无影响，但成本显著更高。
