Background: Optimal post-operative pain relief is critical in pediatric surgery; however, systemic pain medications are associated with a host of unwanted side effects. The use of continuous local analgesic infusion pumps provides adequate pain relief while avoiding serious complications of more systemic treatment. While many reports document the effectiveness of these techniques in the adult population, no prospective studies demonstrate the safety and efficacy of these devices in pediatric surgery.
Methods: The present study is a prospective, randomized, double-blind study employing the On-Q pain pump in 24 patients (mean age: 12 years). All patients underwent alveolar bone grafting for cleft repair following iliac crest bone harvest. The On-Q pain pump catheter was placed in the subfascial plane of the iliac crest harvest site. While 12 patients received 0.2% bupivicaine solution, 12 patients received 0.9% normal saline placebo via the pain pump system. Over the immediate 24-hour post-operative period, oral and intravenous pain medication was measured, as were required levels of antiemetic (Zofran).
Results: Within the first 12 post-operative hours, patients receiving bupivacaine infusion via the On-Q pain pump required significantly less (p=0.02) pain medication compared to the placebo group. Between 12 and 24 hours post-procedure, an even more statistically significant decrease in analgesic requirement was noted (p=0.004). Finally, patients in the control group were 9 times more likely to require antiemetic medication (p=0.026). No postoperative morbidity was noted in any member of either study group.
Conclusion: Following iliac crest bone harvest for alveolar cleft repair, continuous infusion of 0.2% bupivacaine via the On-Q pain pump greatly diminishes narcotic requirement for adequate pain control. Use of the On-Q pain pump system to provide post-operative local analgesia is safe and reliable.