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Published on: November 6, 2019
Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review
James K Hamill1, Jamie-Lee Rahiri2, Andrew Liley3
1Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand.
Insights
Intraperitoneal local anesthetic (IPLA) may reduce pain and opioid use in children after abdominal surgery. However, more research is needed due to significant risk of bias and potential dose limitations in pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Systematic reviews indicate intraperitoneal local anesthetic (IPLA) efficacy in adult pain management.
- Limited research exists on IPLA's effectiveness in pediatric populations.
Purpose of the Study:
- To determine if IPLA reduces pain following pediatric abdominal surgery compared to a control group.
- To synthesize current evidence on IPLA in children undergoing abdominal procedures.
Main Methods:
- Conducted a systematic search of multiple databases for randomized controlled trials (RCTs) of IPLA versus placebo in pediatric patients (≤18 years).
- Included studies reporting pain or opioid use outcomes.
- Performed independent data extraction and quality assessment.
Main Results:
- Identified three published and one unpublished RCT, all involving laparoscopic surgery.
- Qualitative synthesis suggests IPLA may decrease pain scores, opioid consumption, time to first opioid, and need for rescue analgesia.
- No significant effect on hospital stay was observed. Risk of bias was noted as significant.
Conclusions:
- IPLA shows promise for pain management in pediatric surgery.
- High peritoneal surface area to volume ratio in children may necessitate dose limitations.
- IPLA in pediatric surgery remains understudied compared to adult applications.
Abstract:
Introduction Systematic reviews report intraperitoneal local anesthetic (IPLA) effective in adults but until now no review has addressed IPLA in children. The objective of this review was to answer the question, does IPLA compared with control reduce pain after pediatric abdominal surgery. Materials and Methods Data sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray.
Study Selection:
Independent duplicate searching for randomized controlled trials of IPLA versus no IPLA/placebo in children ≤ 18 years of age, reporting pain, or opioid use outcomes.
Data Extraction:
Independent duplicate data extraction and quality assessment using standardized fields. Results The selection process uncovered three eligible published trials and one unpublished study, all in laparoscopy surgery. Qualitative synthesis suggested that IPLA may reduce pain scores, opioid use, time to first opioid, and the need for rescue analgesia, with no effect on hospital stay. Risk of bias was significant. Conclusions IPLA appears promising in pediatric surgery. The high absorptive capacity of the peritoneum and high peritoneal surface area to volume ratio in children presents a dose limitation. In comparison to adult surgery, IPLA has been understudied in pediatric surgery.
